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902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38079.9,"maximum":61661.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38079.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38079.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60166.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38460.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":54280.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":54280.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":38460.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":48670.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54280.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":54280.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51001.86},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39603.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49040.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60166.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61661.81},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":38079.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38079.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Or Islet Cell Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48754.58,"maximum":78947.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48754.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48754.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":77032.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49242.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":69496.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":69496.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":49242.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":62313.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69496.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":69496.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65298.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":50704.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62787.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":77032.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78947.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":48754.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48754.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37057.34,"maximum":60006.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37057.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37057.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58550.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37427.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":52822.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":52822.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37427.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47363.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52822.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":52822.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49632.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38539.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47723.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58550.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60006.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37057.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37057.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28645.19,"maximum":46384.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28645.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28645.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45259.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28931.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40831.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40831.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28931.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36611.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40831.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40831.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38365.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29791.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36890.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45259.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46384.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28645.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28645.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19580.1,"maximum":31705.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30936.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19775.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27910.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27910.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19775.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25025.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27910.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27910.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26224.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20363.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25215.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30936.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31705.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19580.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81654.43,"maximum":132220.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":81654.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":81654.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":129014.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":82470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":116393.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":116393.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":82470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":104363.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":116393.36},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":116393.36},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109362.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":84920.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":105156.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":129014.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":132220.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":81654.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":81654.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40288.76,"maximum":65238.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40288.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40288.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":63656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":57429.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":57429.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":40691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":51493.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57429.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":57429.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53960.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41900.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51884.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63656.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65238.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":40288.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40288.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36909.22,"maximum":59766.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36909.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36909.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58316.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37278.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":52611.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":52611.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37278.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47174.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52611.83},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":52611.83},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49433.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38385.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47532.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58316.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59766.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":36909.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36909.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":293401.25,"maximum":475097.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":293401.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":293401.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":463573.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":296335.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":418225.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":418225.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":296335.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":374999.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":418225.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":418225.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":392963.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":305137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":377849.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":463573.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":475097.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":293401.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":293401.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48475.33,"maximum":78494.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48475.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48475.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":76591.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48960.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":69098.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":69098.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":48960.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":61956.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69098.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":69098.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64924.86},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":50414.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62427.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76591.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78494.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":48475.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48475.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53463.78,"maximum":86572.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":53463.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":53463.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":84472.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53998.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":76209.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":76209.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":53998.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":68332.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":76209.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":76209.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":71606.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":55602.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":68852.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84472.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86572.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":53463.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":53463.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35968.2,"maximum":58242.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35968.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35968.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":56829.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":51270.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":51270.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":36327.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":45971.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51270.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":51270.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48173.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37406.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46320.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56829.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58242.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":35968.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35968.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21588.53,"maximum":34957.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21588.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21588.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34109.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21804.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30773.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30773.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21804.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27592.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30773.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30773.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28914.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22452.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27802.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34109.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34957.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21588.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21588.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38933.96,"maximum":63044.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38933.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38933.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":61515.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39323.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":55497.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":55497.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":39323.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":49761.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55497.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":55497.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52145.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40491.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50140.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61515.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63044.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":38933.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38933.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26579.02,"maximum":43038.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26579.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26579.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41994.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37886.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37886.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33970.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37886.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37886.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35598.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27642.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34229.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41994.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43038.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26579.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26579.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30892.1,"maximum":50022.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30892.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30892.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48809.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31201.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44034.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44034.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31201.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39483.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44034.79},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44034.79},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41374.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32127.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39783.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48809.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50022.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30892.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30892.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21125.15,"maximum":34207.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21125.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21125.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33377.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21336.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30112.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30112.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21336.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27000.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30112.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30112.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28293.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21970.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27205.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33377.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34207.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21125.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21125.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17141.59,"maximum":27756.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17141.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17141.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27083.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17313.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24434.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24434.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17313.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21908.86},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24434.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24434.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22958.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17827.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22075.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27083.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27756.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17141.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17141.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":190405.61,"maximum":308318.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":190405.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":190405.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":300840.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":192309.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":271411.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":271411.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":192309.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":243359.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":271411.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":271411.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":255017.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":198021.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":245209.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":300840.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":308318.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":190405.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":190405.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76992.79,"maximum":124672.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76992.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76992.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":121648.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":77762.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":109748.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":109748.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":77762.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":98405.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109748.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":109748.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103119.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":80072.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":99153.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":121648.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":124672.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":76992.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76992.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":144212.52,"maximum":233519.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":144212.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":144212.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":227855.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":145654.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":205566.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":205566.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":145654.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":184319.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":205566.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":205566.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":193149.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":149981.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":185720.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":227855.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":233519.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":144212.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":144212.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94111.96,"maximum":152393.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":94111.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":94111.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":148696.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":95053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":134150.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":134150.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":95053.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":120285.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":134150.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":134150.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":126047.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":97876.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":121199.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":148696.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":152393.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":94111.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":94111.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70053.67,"maximum":113436.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":70053.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":70053.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":110684.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":70754.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":99857.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":99857.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":70754.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":89536.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":99857.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":99857.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":93825.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":72855.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":90216.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":110684.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":113436.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":70053.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":70053.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31505.64,"maximum":51016.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31505.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31505.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49778.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31820.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44909.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44909.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31820.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":40267.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44909.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44909.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42196.7},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32765.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40573.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49778.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51016.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31505.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31505.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40822.8,"maximum":66103.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40822.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40822.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":64500.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41231.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":58190.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":58190.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":41231.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":52176.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58190.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":58190.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54675.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":42455.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52572.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64500.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66103.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":40822.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40822.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23179.78,"maximum":37534.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23179.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23179.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36624.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23411.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33041.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33041.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23411.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29626.33},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33041.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33041.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31045.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24106.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29851.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36624.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37534.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23179.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23179.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14915.07,"maximum":24151.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14915.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14915.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23565.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15064.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21260.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21260.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15064.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19063.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21260.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21260.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19976.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15511.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19208.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23565.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24151.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14915.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14915.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30442.31,"maximum":49294.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30442.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30442.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48098.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":43393.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":43393.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":30746.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":38908.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43393.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":43393.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40772.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31660.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39204.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48098.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49294.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30442.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30442.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14478.87,"maximum":23445.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22876.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14623.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20638.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20638.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14623.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18505.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20638.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20638.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19392.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15058.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18646.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22876.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23445.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14478.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11298.41,"maximum":18295.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11298.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11298.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11411.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16105.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16105.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11411.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14440.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16105.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16105.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15132.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11750.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14550.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17851.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18295.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11298.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11298.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26299.09,"maximum":42585.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41552.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37487.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37487.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33613.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37487.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37487.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35223.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27351.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33868.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41552.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42585.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26299.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26299.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4891.97,"maximum":7921.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7729.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4940.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6973.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6973.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4940.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6252.48},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6973.2},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6973.2},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6552.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5087.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6300.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7729.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7921.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4891.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14167.68,"maximum":22941.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22384.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14309.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20195.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20195.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14309.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18107.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20195.16},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20195.16},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18975.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14734.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18245.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22384.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22941.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14167.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6545.05,"maximum":10598.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6545.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6545.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10341.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6610.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9329.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9329.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6610.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8365.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9329.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9329.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8766.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6806.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8428.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10341.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10598.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6545.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6545.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4634.46,"maximum":7504.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4680.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6606.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6606.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4680.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5923.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6606.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6606.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6207.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4819.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5968.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7504.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4634.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45430.76,"maximum":73564.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":71780.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45885.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":64758.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":64758.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":45885.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":58065.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":64758.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":64758.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60847.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":47247.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58506.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":71780.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":73564.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":45430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45430.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16457.4,"maximum":26649.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16457.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16457.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16621.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23459.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23459.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16621.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21034.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23459.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23459.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22042.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17115.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21194.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26002.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26649.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16457.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16457.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30322.73,"maximum":49100.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30322.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30322.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47909.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30625.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":43223.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":43223.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":30625.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":38755.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43223.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":43223.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40612.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31535.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39050.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47909.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49100.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30322.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30322.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16342.57,"maximum":26463.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16342.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16342.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25821.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16506.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23295.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23295.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16506.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20887.63},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23295.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23295.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21888.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16996.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21046.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25821.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26463.11},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16342.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16342.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18486.21,"maximum":29934.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18486.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18486.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29208.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26350.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26350.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23627.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26350.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26350.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24759.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19225.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23807.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29208.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29934.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18486.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18486.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11978.53,"maximum":19396.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11978.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11978.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18926.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12098.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17074.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17074.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12098.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15309.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17074.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17074.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16043.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12457.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15426.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18926.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19396.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11978.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11978.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29402.09,"maximum":47610.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29402.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29402.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46455.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29696.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":41910.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":41910.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":29696.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":37579.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41910.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":41910.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39379.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30578.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37864.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46455.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47610.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":29402.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29402.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21409.16,"maximum":34667.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21409.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21409.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33826.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21623.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30517.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30517.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21623.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27363.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30517.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30517.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28674.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22265.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27571.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33826.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34667.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21409.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21409.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21812.74,"maximum":35320.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21812.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21812.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34464.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22030.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31092.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31092.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22030.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27879.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31092.72},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31092.72},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29214.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28091.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34464.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35320.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21812.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21812.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33886.39,"maximum":54871.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33886.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33886.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53540.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34225.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":48302.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":48302.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":34225.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":43310.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48302.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":48302.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45385.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35241.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43639.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53540.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54871.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":33886.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33886.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16242.02,"maximum":26300.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16242.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16242.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23151.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23151.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20759.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23151.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23151.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21753.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16891.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20916.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26300.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16242.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16242.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13200.16,"maximum":21374.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13200.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13200.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20856.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18816.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18816.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13332.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16871.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18816.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18816.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17679.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13728.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16999.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20856.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21374.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13200.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13200.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22367.85,"maximum":36219.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22367.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22367.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35341.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22591.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31883.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31883.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22591.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28588.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31883.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31883.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29958.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23262.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28805.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35341.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36219.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22367.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22367.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11024.59,"maximum":17851.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11024.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11024.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17418.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11134.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15714.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15714.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11134.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14090.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15714.88},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15714.88},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14765.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11465.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14197.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17418.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17851.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11024.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11024.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7986.82,"maximum":12932.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7986.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7986.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12619.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8066.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11384.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11384.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8066.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10208.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11384.72},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11384.72},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10697.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8306.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10285.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12619.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12932.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7986.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7986.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26234.54,"maximum":42480.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26234.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26234.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41450.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26496.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37395.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37395.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26496.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33530.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37395.72},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37395.72},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35136.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27283.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33785.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41450.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42480.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26234.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26234.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14938.85,"maximum":24190.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14938.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14938.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23603.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15088.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21294.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21294.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15088.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19093.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21294.41},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21294.41},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20008.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15536.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19238.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23603.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24190.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14938.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14938.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11738.69,"maximum":19008.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11738.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11738.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18547.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11856.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16732.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16732.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11856.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15003.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16732.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16732.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15722.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12208.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15117.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18547.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19008.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11738.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11738.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12306.7,"maximum":19927.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19444.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17542.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17542.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12429.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15729.33},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17542.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17542.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16482.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12798.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15848.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19444.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19927.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12306.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12306.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6653.08,"maximum":10773.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6719.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9483.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9483.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6719.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8503.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9483.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9483.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8910.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8568.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10511.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10773.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6653.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10374.37,"maximum":16798.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10374.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10374.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16391.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10478.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14788.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14788.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10478.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13259.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14788.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14788.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13894.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10789.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13360.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16391.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16798.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10374.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10374.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6927.57,"maximum":11217.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6927.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6927.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10945.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6996.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9874.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9874.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6996.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8854.21},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9874.83},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9874.83},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9278.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7204.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8921.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10945.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11217.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6927.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6927.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15784.07,"maximum":25558.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15784.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15784.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15941.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22499.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22499.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15941.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20173.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22499.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22499.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21140.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16415.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20327.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25558.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15784.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15784.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8802.83,"maximum":14254.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13908.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8890.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12547.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12547.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8890.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11250.99},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12547.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12547.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11789.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9154.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11336.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13908.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14254.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8802.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11615.03,"maximum":18807.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11615.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11615.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18351.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11731.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16556.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16556.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11731.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14845.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16556.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16556.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15556.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12079.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14958.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18351.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18807.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11615.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11615.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8431.17,"maximum":13652.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8431.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8431.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13321.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8515.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12018.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12018.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8515.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10775.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12018.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12018.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11292.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8768.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10857.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13321.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13652.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8431.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8431.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6249.49,"maximum":10119.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6249.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6249.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9874.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6311.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8908.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8908.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6311.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7987.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8908.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8908.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8370.18},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8048.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9874.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10119.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6249.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6249.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18732.84,"maximum":30333.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18732.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18732.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29597.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18920.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26702.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26702.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18920.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23942.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26702.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26702.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25089.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19482.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24124.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29597.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30333.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18732.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18732.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11939.12,"maximum":19332.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18863.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12058.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17018.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17018.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12058.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15259.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17018.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17018.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15990.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15375.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18863.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19332.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11939.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9537.98,"maximum":15444.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9537.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9537.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15070.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9633.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13595.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13595.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9633.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12190.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13595.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13595.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12774.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9919.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12283.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15070.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15444.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9537.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9537.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13663.54,"maximum":22125.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13663.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13663.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21588.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13800.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19476.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19476.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13800.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17463.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19476.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19476.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18300.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14210.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17596.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21588.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22125.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13663.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13663.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6864.38,"maximum":11115.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10845.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6933.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9784.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9784.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6933.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8773.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9784.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9784.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9193.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7138.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8840.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10845.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11115.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6864.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6864.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4650.09,"maximum":7529.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4650.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4650.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7347.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4696.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6628.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6628.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4696.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5943.33},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6628.41},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6628.41},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6228.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5988.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7347.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7529.77},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4650.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4650.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9978.94,"maximum":16158.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9978.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9978.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15766.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10078.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14224.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14224.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10078.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12754.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14224.36},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14224.36},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13365.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10378.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12851.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15766.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16158.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9978.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9978.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5873.08,"maximum":9510.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5931.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8371.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8371.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5931.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7506.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8371.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8371.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7866.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6108.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7563.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9279.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9510.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5873.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5427.37,"maximum":8788.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8575.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5481.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7736.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7736.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5481.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6936.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7736.38},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7736.38},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7269.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5644.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6989.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8575.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8788.4},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5427.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11311.32,"maximum":18316.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11311.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11311.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17871.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11424.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16123.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16123.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11424.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14457.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16123.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16123.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15149.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11763.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14567.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17871.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18316.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11311.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11311.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6971.06,"maximum":11288.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6971.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6971.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7040.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9936.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9936.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7040.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8909.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9936.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9936.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9336.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7249.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8977.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11014.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11288.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6971.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6971.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5137.93,"maximum":8319.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5137.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5137.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8117.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5189.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7323.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7323.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5189.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6566.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7323.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7323.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6881.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5343.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6616.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8117.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8319.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5137.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5137.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10900.26,"maximum":17650.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10900.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10900.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17222.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11009.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15537.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15537.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11009.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13931.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15537.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15537.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14599.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11336.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14037.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17222.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17650.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10900.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10900.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7003.67,"maximum":11340.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11065.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7073.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9983.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9983.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7073.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8951.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9983.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9983.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9380.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7283.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9019.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11065.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11340.86},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7003.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13028.26,"maximum":21096.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20584.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13158.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18570.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18570.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13158.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16651.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18570.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18570.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17449.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13549.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16778.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20584.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21096.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13028.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5606.74,"maximum":9078.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5606.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5606.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8858.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5662.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7992.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7992.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5662.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7166.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7992.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7992.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7509.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5831.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7220.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8858.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9078.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5606.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5606.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12297.87,"maximum":19913.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19430.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12420.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17529.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17529.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12420.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15718.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17529.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17529.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16471.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12789.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15837.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19430.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19913.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12297.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6085.07,"maximum":9853.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6085.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6085.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9614.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6145.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8673.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8673.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6145.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7777.39},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8673.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8673.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8149.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7836.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9614.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9853.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6085.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6085.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15529.28,"maximum":25146.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24536.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22136.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22136.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15684.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19848.15},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22136.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22136.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20798.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16150.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19999.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24536.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25146.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15529.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15529.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9483.62,"maximum":15356.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9483.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9483.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14984.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9578.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13518.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13518.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9578.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12121.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13518.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13518.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12701.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9862.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12213.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14984.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15356.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9483.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9483.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6494.09,"maximum":10515.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6494.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6494.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10260.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6559.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9256.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9256.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6559.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8300.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9256.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9256.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8697.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6753.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8363.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10260.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10515.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6494.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6494.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15436.2,"maximum":24995.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24389.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15590.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22003.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22003.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15590.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19729.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22003.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22003.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20674.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19879.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24389.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24995.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15436.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15436.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8851.07,"maximum":14332.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8851.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8851.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13984.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12616.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12616.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8939.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11312.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12616.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12616.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11854.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9205.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11398.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13984.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14332.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8851.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8851.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6214.84,"maximum":10063.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6214.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6214.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9819.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6276.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8858.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8858.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6276.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7943.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8858.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8858.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8323.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6463.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8003.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9819.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10063.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6214.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6214.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5216.74,"maximum":8447.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8242.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5268.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7436.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7436.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5268.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6667.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7436.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7436.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6986.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5425.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6718.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8242.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8447.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5216.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5216.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14743.85,"maximum":23874.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14743.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14743.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23295.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14891.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21016.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21016.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14891.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18844.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21016.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21016.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19747.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15333.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18987.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23295.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23874.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14743.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14743.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6898.36,"maximum":11170.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6898.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6898.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10899.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6967.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9833.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9833.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6967.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8816.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9833.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9833.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9239.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7174.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8883.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10899.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11170.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6898.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6898.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10145.4,"maximum":16428.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10145.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10145.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16029.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10246.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14461.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14461.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10246.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12966.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14461.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14461.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13588.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10551.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13065.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16029.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16428.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10145.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10145.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6021.2,"maximum":9749.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6021.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6021.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9513.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6081.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8582.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8582.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6081.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7695.76},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8582.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8582.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8064.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6262.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7754.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9513.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9749.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6021.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6021.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8395.84,"maximum":13595.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8395.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8395.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13265.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11967.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11967.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8479.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10730.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11967.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11967.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11244.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8731.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10812.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13265.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13595.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8395.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8395.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28980.16,"maximum":46926.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29269.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":41309.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":41309.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":29269.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":37039.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41309.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":41309.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38814.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30139.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37321.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46926.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28980.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14819.27,"maximum":23996.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14819.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14819.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23414.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14967.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21123.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21123.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14967.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18940.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21123.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21123.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19848.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15412.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19084.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23414.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23996.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14819.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14819.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10846.58,"maximum":17563.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10846.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10846.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17137.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10955.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15461.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15461.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10955.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13863.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15461.13},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15461.13},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14527.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11280.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13968.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17137.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17563.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10846.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10846.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25455.9,"maximum":41220.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25455.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25455.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25710.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":36285.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":36285.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25710.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32535.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36285.82},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":36285.82},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34094.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26474.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32782.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41220.09},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25455.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25455.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11774.02,"maximum":19065.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11774.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11774.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18602.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11891.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16783.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16783.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11891.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15048.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16783.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16783.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15769.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12244.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15162.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18602.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19065.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11774.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11774.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8168.91,"maximum":13227.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8168.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8168.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12906.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8250.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11644.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11644.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8250.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10440.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11644.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11644.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10940.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8495.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10520.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12906.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13227.7},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8168.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8168.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14386.46,"maximum":23295.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14386.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14386.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22730.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20507.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20507.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14530.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18387.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20507.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20507.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19268.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14961.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18527.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22730.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23295.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14386.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14386.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8639.08,"maximum":13989.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13649.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12314.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12314.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11041.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12314.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12314.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11570.65},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8984.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11125.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13649.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13989.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8639.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5415.82,"maximum":8769.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8557.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5469.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7719.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7719.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5469.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6922.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7719.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7719.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7253.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5632.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6974.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8557.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8769.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5415.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5415.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5106.67,"maximum":8269.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5106.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5106.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8068.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5157.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7279.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7279.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5157.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6526.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7279.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7279.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6839.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5310.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6576.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8068.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8269.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5106.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5106.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9046.74,"maximum":14649.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9046.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9046.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14293.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9137.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12895.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12895.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9137.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11562.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12895.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12895.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12116.65},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9408.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11650.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14293.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14649.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9046.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9046.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4987.09,"maximum":8075.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4987.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4987.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5036.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7108.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7108.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5036.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6374.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7108.79},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7108.79},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6679.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5186.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6422.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8075.47},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4987.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4987.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8032.34,"maximum":13006.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8032.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8032.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12691.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11449.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11449.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8112.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10266.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11449.61},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11449.61},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10758.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8353.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10344.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12691.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13006.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8032.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8032.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5015.63,"maximum":8121.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5015.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5015.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7924.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5065.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7149.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7149.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5065.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6410.53},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7149.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7149.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6717.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5216.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6459.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7924.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8121.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5015.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5015.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10623.05,"maximum":17201.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10623.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10623.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16784.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10729.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15142.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15142.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10729.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13577.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15142.5},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15142.5},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14227.85},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13680.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16784.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17201.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10623.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10623.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6227.07,"maximum":10083.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6227.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6227.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9838.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8876.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8876.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7958.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8876.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8876.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8340.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6476.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8019.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9838.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10083.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6227.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6227.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4695.61,"maximum":7603.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4695.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4695.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7419.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4742.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6693.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6693.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4742.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6001.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6693.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6693.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6289.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4883.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6047.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7419.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7603.48},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4695.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4695.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21348.69,"maximum":34569.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21348.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21348.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21562.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30431.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30431.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21562.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27286.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30431.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30431.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28593.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22202.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27493.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33730.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34569.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21348.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21348.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13738.96,"maximum":22247.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21707.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13876.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19584.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19584.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13876.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17559.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19584.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19584.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18401.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14288.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17693.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21707.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22247.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13738.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22100.83,"maximum":35787.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22100.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22100.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34919.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31503.37},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31503.37},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22321.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28247.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31503.37},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31503.37},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29600.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22984.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28462.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34919.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35787.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22100.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22100.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12844.81,"maximum":20799.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20294.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16417.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17203.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13358.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16541.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20294.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20799.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11074.19,"maximum":17932.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11074.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11074.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17497.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11184.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15785.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15785.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11184.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14154.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15785.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15785.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14832.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11517.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14261.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17497.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17932.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11074.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11074.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20773.2,"maximum":33637.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20773.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20773.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32821.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20980.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29610.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29610.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20980.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26550.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29610.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29610.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27822.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21604.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26752.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32821.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33637.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20773.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20773.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22697.38,"maximum":36753.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35861.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22924.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":32353.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":32353.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22924.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29009.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32353.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":32353.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30399.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29230.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35861.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36753.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22697.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24583.5,"maximum":39807.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38841.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24829.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35042.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35042.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24829.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31420.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35042.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35042.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32925.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25566.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31659.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38841.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39807.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24583.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24583.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41638.81,"maximum":67424.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41638.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41638.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":65789.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42055.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":59353.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":59353.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":42055.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":53219.03},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59353.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":59353.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55768.44},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":43304.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53623.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65789.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67424.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":41638.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41638.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32346.78,"maximum":52378.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32346.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32346.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51107.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":46108.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":46108.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":32670.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":41342.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46108.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":46108.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43323.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33640.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41657.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51107.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52378.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":32346.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32346.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46731.21,"maximum":75670.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46731.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46731.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":73835.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47198.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":66612.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":66612.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":47198.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":59727.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66612.46},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":66612.46},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62588.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48600.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60181.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":73835.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75670.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":46731.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46731.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28694.11,"maximum":46463.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28694.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28694.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45336.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28981.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40901.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40901.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28981.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36674.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40901.69},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40901.69},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38431.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29841.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36953.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45336.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46463.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28694.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28694.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35849.3,"maximum":58049.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35849.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35849.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":56641.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36207.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":51100.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":51100.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":36207.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":45819.39},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51100.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":51100.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48014.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37283.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46167.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":56641.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58049.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":35849.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35849.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24162.93,"maximum":39126.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38177.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34442.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34442.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30882.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34442.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34442.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32362.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25129.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31117.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38177.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39126.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24162.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17346.11,"maximum":28088.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27406.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17519.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24725.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24725.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17519.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22170.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24725.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24725.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23232.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18039.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22338.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27406.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28088.11},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17346.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28030.3,"maximum":45388.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28030.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28030.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44287.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28310.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":39955.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":39955.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28310.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":35825.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39955.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":39955.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37542.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29151.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36098.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44287.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45388.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28030.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28030.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22365.13,"maximum":36215.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22365.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22365.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35336.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31880.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31880.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22588.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28585.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31880.11},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31880.11},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29954.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23259.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28802.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35336.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36215.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22365.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22365.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48446.8,"maximum":78448.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48446.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48446.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":76545.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48931.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":69057.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":69057.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":48931.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":61920.39},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69057.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":69057.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64886.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":50384.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62391.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76545.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78448.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":48446.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48446.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40811.25,"maximum":66084.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":64481.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41219.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":58173.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":58173.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":41219.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":52161.31},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58173.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":58173.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54660.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":42443.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52557.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64481.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66084.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":40811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40811.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31379.94,"maximum":50812.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31379.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31379.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49580.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44730.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44730.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31693.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":40107.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44730.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44730.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42028.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32635.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40411.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49580.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50812.74},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31379.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31379.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37818.99,"maximum":61239.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37818.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37818.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":59754.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38197.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":53908.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":53908.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":38197.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":48336.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53908.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":53908.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50652.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39331.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48704.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59754.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61239.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37818.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37818.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24503.33,"maximum":39677.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24503.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24503.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38715.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24748.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34927.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34927.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24748.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31317.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34927.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34927.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32818.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25483.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31556.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38715.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39677.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24503.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24503.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10898.9,"maximum":17648.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10898.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10898.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17220.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11007.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15535.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15535.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11007.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13930.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15535.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15535.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14597.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11334.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14035.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17220.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17648.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10898.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10898.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6244.73,"maximum":10111.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6244.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6244.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9866.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8901.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8901.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7981.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8901.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8901.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8363.81},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6494.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8042.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9866.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10111.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6244.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6244.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4913.03,"maximum":7955.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4913.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4913.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7762.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4962.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7003.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7003.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4962.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6279.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7003.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7003.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6580.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6327.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7762.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7955.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4913.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4913.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13458.35,"maximum":21792.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13458.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13458.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21264.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19184.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19184.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13592.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17201.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19184.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19184.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18025.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13996.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17332.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21264.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21792.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13458.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13458.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4703.08,"maximum":7615.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7430.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4750.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6703.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6703.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4750.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6011.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6703.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6703.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6299.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4891.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6056.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7430.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7615.58},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4703.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4069.17,"maximum":6589.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4069.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4069.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6429.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4109.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5800.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5800.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4109.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5200.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5800.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5800.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5449.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5240.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6429.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6589.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4069.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4069.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15034.65,"maximum":24345.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15034.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15034.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23754.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15185.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21430.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21430.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15185.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19215.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21430.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21430.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20136.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15636.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19362.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23754.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24345.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15034.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15034.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7270.69,"maximum":11773.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7270.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7270.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11487.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7343.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10363.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10363.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7343.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9292.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10363.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10363.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9737.91},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7561.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9363.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11487.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11773.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7270.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7270.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18387.01,"maximum":29773.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18387.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18387.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29051.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18570.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26209.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26209.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18570.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23500.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26209.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26209.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24626.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19122.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23679.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29051.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29773.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18387.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18387.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11597.36,"maximum":18779.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11597.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11597.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18323.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11713.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16531.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16531.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11713.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14822.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16531.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16531.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15532.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12061.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14935.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18323.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18779.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11597.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11597.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6316.75,"maximum":10228.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9980.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6379.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9004.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9004.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6379.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8073.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9004.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9004.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8460.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6569.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8134.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9980.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10228.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6316.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6316.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8722.65,"maximum":14124.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13781.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8809.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12433.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12433.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8809.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11148.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12433.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12433.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11682.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9071.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11233.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13781.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14124.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8722.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8722.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":191.95,"10th_percentile":191.95,"90th_percentile":191.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":158.57,"10th_percentile":158.57,"90th_percentile":158.57,"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":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5768.45,"maximum":9340.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5768.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5768.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9114.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5826.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8222.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8222.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5826.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7372.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8222.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8222.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7725.9},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5999.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7428.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9114.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9340.7},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5768.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5768.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3845.63,"maximum":6227.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3845.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3845.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3884.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5481.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5481.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3884.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4915.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5481.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5481.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5150.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3999.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4952.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6076.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6227.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3845.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3845.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10612.17,"maximum":17184.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10612.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10612.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16767.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10718.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15127.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15127.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10718.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13563.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15127.0},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15127.0},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14213.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11036.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13666.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16767.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17184.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10612.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10612.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4307.65,"maximum":6975.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4307.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4307.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6806.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6140.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6140.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4350.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5505.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6140.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6140.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5769.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4479.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5547.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6806.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6975.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4307.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4307.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3092.13,"maximum":5007.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3092.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3092.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4885.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3123.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":4407.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":4407.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3123.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":3952.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":4407.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":4407.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4141.41},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3215.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3982.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4885.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5007.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3092.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3092.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11093.22,"maximum":17962.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11093.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11093.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17527.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15812.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15812.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14178.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15812.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15812.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14857.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11536.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14286.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17527.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17962.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11093.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11093.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7253.02,"maximum":11744.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11459.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7325.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10338.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10338.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7325.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9270.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10338.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10338.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9714.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7543.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9340.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11459.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11744.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7253.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4889.93,"maximum":7918.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4889.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4889.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7726.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6970.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6970.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4938.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6249.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6970.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6970.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6549.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5085.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6297.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7726.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7918.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4889.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4889.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8130.18,"maximum":13164.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8130.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8130.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12845.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8211.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11589.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11589.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8211.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10391.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11589.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11589.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10889.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8455.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10470.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12845.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13164.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8130.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8130.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4573.99,"maximum":7406.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4573.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4573.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7226.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4619.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6519.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6519.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4619.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5846.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6519.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6519.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6126.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4756.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5890.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7226.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7406.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4573.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4573.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8085.34,"maximum":13092.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12774.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8166.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11525.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11525.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8166.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10333.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11525.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11525.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10829.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8408.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10412.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12774.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13092.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8085.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8085.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5130.45,"maximum":8307.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8106.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5181.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7313.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7313.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5181.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6557.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7313.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7313.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6871.41},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5335.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6607.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8106.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8307.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5130.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10706.62,"maximum":17336.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10813.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15261.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15261.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10813.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13684.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15261.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15261.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14339.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11134.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13788.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16916.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17336.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10706.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10706.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6204.65,"maximum":10047.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6204.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6204.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9803.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6266.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8844.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8844.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6266.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7930.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8844.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8844.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8310.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6452.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7990.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9803.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10047.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6204.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6204.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8180.46,"maximum":13246.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12925.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8262.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8262.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10455.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10956.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10535.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12925.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13246.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4998.64,"maximum":8094.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7897.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5048.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7125.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7125.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5048.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6388.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7125.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7125.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6694.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5198.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6437.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7897.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8094.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4998.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4998.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3846.31,"maximum":6228.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3846.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3846.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6077.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5482.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5482.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3884.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4916.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5482.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5482.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5151.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4000.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4953.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6077.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6228.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3846.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3846.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4768.99,"maximum":7722.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4768.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4768.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7535.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6797.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6797.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6095.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6797.9},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6797.9},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6387.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4959.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6141.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7535.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7722.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4768.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4768.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5922.0,"maximum":9589.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5922.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5922.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9356.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5981.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8441.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8441.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5981.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7568.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8441.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8441.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7931.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6158.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7626.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9356.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9589.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5922.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5922.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9184.67,"maximum":14872.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9184.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9184.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14511.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9276.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13092.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13092.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9276.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11739.03},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13092.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13092.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12301.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9552.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11828.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14511.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14872.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9184.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9184.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7464.33,"maximum":12086.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7464.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7464.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7538.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10639.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10639.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7538.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9540.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10639.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10639.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9997.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7762.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9612.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11793.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12086.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7464.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7464.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5593.15,"maximum":9056.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5649.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7972.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7972.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5649.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7148.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7972.69},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7972.69},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7491.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5816.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7203.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9056.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5593.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5593.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11932.33,"maximum":19321.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11932.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11932.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18853.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17008.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17008.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12051.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15250.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17008.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17008.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15981.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12409.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15366.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18853.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19321.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11932.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11932.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6950.67,"maximum":11255.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6950.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6950.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7020.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9907.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9907.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7020.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8883.73},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9907.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9907.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9309.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7228.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8951.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11255.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6950.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6950.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5410.38,"maximum":8760.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5410.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5410.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8548.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5464.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7712.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7712.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5464.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6915.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7712.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7712.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7246.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5626.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6967.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8548.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8760.89},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5410.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5410.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23912.21,"maximum":38720.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37781.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34085.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34085.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24151.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30562.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34085.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34085.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32026.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24868.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30794.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37781.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38720.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23912.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17524.12,"maximum":28376.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27688.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17699.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17699.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22397.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23470.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18225.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22568.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27688.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28376.36},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17524.12,"maximum":28376.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27688.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17699.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17699.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22397.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24979.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23470.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18225.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22568.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27688.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28376.36},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17524.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24540.02,"maximum":39737.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24540.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24540.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24785.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34980.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34980.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24785.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31364.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34980.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34980.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32867.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25521.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31603.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39737.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24540.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24540.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15592.47,"maximum":25248.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15592.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15592.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24636.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15748.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22226.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22226.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15748.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19928.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22226.11},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22226.11},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20883.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16216.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20080.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24636.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25248.49},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15592.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15592.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9256.69,"maximum":14989.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9256.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9256.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14625.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9349.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13194.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13194.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9349.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11831.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13194.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13194.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12397.84},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9626.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11921.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14625.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14989.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9256.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9256.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13159.4,"maximum":21308.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13159.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13159.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18757.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18757.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16819.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18757.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18757.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17624.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16947.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20791.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21308.67},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13159.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13159.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6132.63,"maximum":9930.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6132.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6132.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9689.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8741.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8741.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6193.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7838.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8741.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8741.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8213.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6377.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7897.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9689.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9930.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6132.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6132.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7615.84,"maximum":12332.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7615.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7615.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12033.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7692.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10855.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10855.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7692.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9733.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10855.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10855.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10200.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7920.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9807.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12033.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12332.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7615.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7615.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5682.16,"maximum":9200.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5682.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5682.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8977.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5738.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8099.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8099.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5738.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7262.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8099.57},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8099.57},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7610.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5909.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7317.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8977.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9200.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5682.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5682.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15974.32,"maximum":25866.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15974.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15974.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25239.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16134.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22770.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22770.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16134.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20416.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22770.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22770.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21395.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20572.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25239.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25866.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15974.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15974.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9192.82,"maximum":14885.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9192.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9192.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14524.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9284.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13103.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13103.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9284.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11749.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13103.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13103.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12312.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9560.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11838.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14524.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14885.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9192.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9192.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10428.73,"maximum":16886.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10428.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10428.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16477.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10533.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14865.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14865.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10533.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13329.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14865.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14865.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13967.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10845.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13430.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16477.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16886.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10428.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10428.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12284.96,"maximum":19892.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12284.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12284.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19410.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12407.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17511.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17511.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12407.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15701.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17511.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17511.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16453.71},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12776.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15820.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19410.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19892.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12284.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12284.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7371.25,"maximum":11936.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7371.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7371.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7444.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10507.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10507.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7444.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9421.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10507.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10507.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9872.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7666.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9492.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11936.07},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7371.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7371.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7903.93,"maximum":12798.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7903.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7903.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12488.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7982.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11266.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11266.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7982.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10102.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11266.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11266.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10586.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8220.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10178.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12488.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12798.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7903.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7903.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5339.04,"maximum":8645.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5339.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5339.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8435.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5392.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7610.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7610.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5392.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6823.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7610.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7610.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7150.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5552.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6875.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8435.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8645.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5339.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5339.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5426.01,"maximum":8786.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5426.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5426.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8573.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5480.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7734.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7734.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5480.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6935.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7734.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7734.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7267.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5643.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6987.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8573.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8786.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5426.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5426.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8989.67,"maximum":14556.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8989.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8989.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14203.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9079.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12814.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12814.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9079.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11489.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12814.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12814.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12040.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9349.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11577.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14203.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14556.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8989.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8989.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11664.63,"maximum":18888.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18430.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11781.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16627.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16627.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11781.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14908.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16627.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16627.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15622.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12131.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15022.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18430.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18888.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11664.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6181.55,"maximum":10009.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6181.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6181.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9766.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6243.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8811.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8811.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6243.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7900.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8811.41},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8811.41},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8279.18},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6428.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7960.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9766.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10009.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6181.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6181.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4813.83,"maximum":7794.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4813.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4813.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7605.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4861.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6861.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6861.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4861.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6152.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6861.82},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6861.82},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6447.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5006.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6199.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7605.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7794.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4813.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4813.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30451.15,"maximum":49308.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30451.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30451.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30755.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":43406.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":43406.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":30755.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":38919.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43406.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":43406.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40784.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31669.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39215.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48112.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49308.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30451.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30451.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17149.07,"maximum":27769.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17149.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17149.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27095.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17320.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24444.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24444.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17320.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21918.42},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24444.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24444.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22968.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17835.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22085.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27095.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27769.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17149.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17149.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13005.84,"maximum":21060.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13005.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13005.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13135.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18539.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18539.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13135.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16622.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18539.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18539.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17419.22},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13526.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16749.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20549.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21060.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13005.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13005.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25395.43,"maximum":41122.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25395.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25395.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40124.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25649.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":36199.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":36199.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25649.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32458.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36199.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":36199.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34013.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26411.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32704.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40124.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41122.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25395.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25395.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12253.02,"maximum":19841.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19359.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12375.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17465.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17465.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12375.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15660.73},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17465.93},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17465.93},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16410.94},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12743.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15779.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19359.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19841.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12253.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12253.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9283.87,"maximum":15033.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9283.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9283.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14668.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13233.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13233.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11865.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13233.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13233.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12434.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9655.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11956.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14668.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15033.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9283.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9283.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20222.85,"maximum":32746.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20222.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20222.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31952.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20425.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28826.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28826.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20425.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25847.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28826.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28826.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27085.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21031.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26043.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31952.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32746.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20222.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20222.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9332.79,"maximum":15112.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9332.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9332.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14745.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9426.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13303.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13303.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9426.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11928.34},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13303.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13303.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12499.76},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9706.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12019.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14745.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15112.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9332.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9332.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5469.49,"maximum":8856.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5469.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5469.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8641.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7796.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7796.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5524.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6990.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7796.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7796.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7325.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5688.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7043.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8641.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8856.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5469.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5469.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10617.61,"maximum":17192.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16775.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10723.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15134.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15134.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10723.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13570.49},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15134.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15134.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14220.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11042.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13673.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16775.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17192.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10617.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":215.86,"10th_percentile":215.86,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6631.34,"maximum":10737.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10477.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9452.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9452.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6697.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8475.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9452.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9452.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8881.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6896.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8540.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10477.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10737.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6631.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6631.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5129.77,"maximum":8306.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8105.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7312.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7312.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5181.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6556.42},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7312.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7312.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6870.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5334.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6606.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8105.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8306.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5129.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5129.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11998.91,"maximum":19429.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11998.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11998.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18958.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12118.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17103.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17103.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12118.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15335.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17103.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17103.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16070.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12478.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15452.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18958.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19429.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11998.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11998.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7276.8,"maximum":11783.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11497.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10372.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10372.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9300.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10372.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10372.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9746.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7567.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9371.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11497.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11783.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7276.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5121.62,"maximum":8293.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5121.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5121.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8092.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5172.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7300.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7300.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5172.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6546.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7300.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7300.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6859.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5326.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6595.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8092.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8293.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5121.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5121.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10394.75,"maximum":16831.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10394.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10394.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16423.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10498.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14817.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14817.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10498.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13285.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14817.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14817.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13922.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10810.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13386.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16423.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16831.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10394.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10394.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7229.92,"maximum":11707.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7229.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7229.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11423.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7302.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10305.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10305.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7302.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9240.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10305.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10305.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9683.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7519.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9310.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11423.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11707.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7229.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7229.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5343.8,"maximum":8653.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5343.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5343.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8443.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5397.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7617.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7617.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5397.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6829.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7617.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7617.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7157.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5557.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6881.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8443.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8653.07},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5343.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5343.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10589.07,"maximum":17146.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10589.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10589.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16730.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10694.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15094.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15094.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10694.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13534.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15094.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15094.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14182.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11012.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13636.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16730.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17146.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10589.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10589.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6720.34,"maximum":10882.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6787.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9579.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9579.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6787.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8589.34},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9579.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9579.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9000.81},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6989.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8654.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10618.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10882.08},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6720.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4872.94,"maximum":7890.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4872.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4872.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7699.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4921.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6946.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6946.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4921.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6228.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6946.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6946.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6526.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5067.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6275.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7699.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7890.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4872.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4872.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8393.8,"maximum":13591.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13262.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11964.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11964.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10728.21},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11964.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11964.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11242.14},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8729.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10809.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13262.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13591.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8393.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":127.39,"10th_percentile":127.39,"90th_percentile":127.39,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7526.16,"maximum":12186.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11891.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7601.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10728.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10728.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7601.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9619.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10728.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10728.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10080.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7827.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9692.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11891.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12186.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7526.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5727.68,"maximum":9274.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9049.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5784.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8164.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8164.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5784.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7320.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8164.46},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8164.46},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7671.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5956.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7376.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9049.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9274.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5727.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4362.01,"maximum":7063.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6891.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4405.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6217.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6217.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4405.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5575.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6217.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6217.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5842.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4536.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5617.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6891.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7063.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4362.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8930.56,"maximum":14461.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8930.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8930.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14110.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9019.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12729.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12729.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9019.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11414.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12729.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12729.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11961.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11501.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14110.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14461.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8930.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8930.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":110.0,"10th_percentile":110.0,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":138.55,"10th_percentile":138.55,"90th_percentile":138.55,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"1 through 10","median_amount":109.74,"10th_percentile":109.74,"90th_percentile":109.74,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":158.57,"10th_percentile":158.57,"90th_percentile":158.57,"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":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5475.61,"maximum":8866.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5475.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5475.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8651.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5530.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7805.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7805.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5530.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6998.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7805.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7805.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7333.69},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5694.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7051.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8651.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8866.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5475.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5475.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":310.8,"10th_percentile":310.8,"90th_percentile":310.8,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4270.28,"maximum":6914.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4270.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4270.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6747.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4312.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6087.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6087.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4312.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5457.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6087.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6087.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5719.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4441.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5499.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6747.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6914.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4270.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4270.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"1 through 10","median_amount":974.0,"10th_percentile":974.0,"90th_percentile":974.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12822.39,"maximum":20762.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12822.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12822.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20259.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12950.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18277.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18277.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12950.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16388.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18277.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18277.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17173.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13335.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16513.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20259.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20762.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12822.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12822.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6448.57,"maximum":10442.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6448.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6448.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6513.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9192.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9192.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6513.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8241.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9192.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9192.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8636.81},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6706.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8304.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10442.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6448.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6448.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4866.15,"maximum":7879.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4866.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4866.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7688.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4914.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6936.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6936.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4914.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6219.48},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6936.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6936.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6517.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5060.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6266.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7688.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7879.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4866.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4866.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11986.0,"maximum":19408.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11986.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11986.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18937.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12105.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17085.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17085.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12105.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15319.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17085.31},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17085.31},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16053.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12465.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15435.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18937.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19408.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11986.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11986.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7469.08,"maximum":12094.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7469.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7469.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11801.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7543.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10646.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10646.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7543.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9546.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10646.72},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10646.72},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10003.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7767.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9618.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11801.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12094.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7469.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7469.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4858.68,"maximum":7867.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4858.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4858.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7676.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4907.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6925.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6925.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4907.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6209.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6925.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6925.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6507.41},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5053.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6257.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7676.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7867.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4858.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4858.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6598.72,"maximum":10685.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6598.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6598.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6664.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9406.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9406.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6664.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8433.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9406.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9406.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8837.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6862.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8498.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10425.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10685.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6598.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6598.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":138.55,"10th_percentile":138.55,"90th_percentile":138.55,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4552.25,"maximum":7371.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4552.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4552.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4597.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6488.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6488.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4597.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5818.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6488.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6488.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6097.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4734.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5862.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7192.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7371.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4552.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4552.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":56.07,"10th_percentile":56.07,"90th_percentile":56.07,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5485.8,"maximum":8883.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5485.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5485.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8667.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5540.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7819.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7819.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5540.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7011.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7819.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7819.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7347.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5705.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7064.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8667.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8883.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5485.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5485.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12440.55,"maximum":20144.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19656.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12564.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17733.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17733.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12564.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15900.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17733.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17733.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16662.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12938.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16021.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19656.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20144.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12440.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12440.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6394.21,"maximum":10353.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6394.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6394.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10102.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6458.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9114.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9114.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6458.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8172.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9114.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9114.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8564.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6649.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8234.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10102.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10353.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6394.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6394.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43719.93,"maximum":70794.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":43719.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":43719.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":69077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44157.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":62320.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":62320.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":44157.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":55878.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62320.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":62320.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58555.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45468.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":56303.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70794.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":43719.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":43719.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18675.77,"maximum":30241.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18675.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18675.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18862.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26621.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26621.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18862.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23869.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26621.16},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26621.16},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25013.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19422.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24051.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30241.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18675.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18675.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76904.46,"maximum":124529.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76904.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76904.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":121509.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":77673.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":109622.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":109622.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":77673.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":98292.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":109622.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":109622.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103001.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":79980.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":99039.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":121509.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":124529.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":76904.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76904.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":73882.99,"maximum":119636.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":73882.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":73882.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":116735.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":74621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":105315.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":105315.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":74621.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":94430.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":105315.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":105315.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":98954.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":76838.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":95148.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":116735.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":119636.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":73882.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":73882.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38774.97,"maximum":62787.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38774.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38774.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":61264.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39162.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":55271.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":55271.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":39162.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":49558.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55271.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":55271.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51932.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40325.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49935.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61264.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62787.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":38774.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38774.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67651.85,"maximum":109546.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":67651.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":67651.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":106889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":68328.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":96433.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":96433.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":68328.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":86466.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":96433.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":96433.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":90608.7},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":70357.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":87123.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":106889.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109546.91},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":67651.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":67651.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66468.26,"maximum":107630.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":66468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":66468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":105019.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":67132.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":94746.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":94746.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":67132.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":84953.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":94746.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":94746.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":89023.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":69126.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":85599.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":105019.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":107630.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":66468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":66468.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44675.22,"maximum":72341.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":70586.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45121.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":45121.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":57099.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59835.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46462.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57533.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70586.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72341.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44675.22,"maximum":72341.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":70586.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45121.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":45121.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":57099.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":63681.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59835.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46462.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57533.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70586.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72341.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44675.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52169.45,"maximum":84476.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":52169.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":52169.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":82427.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":74364.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":74364.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":52691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":66678.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74364.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":74364.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69872.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":54256.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":67185.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":82427.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84476.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":52169.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":52169.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36233.18,"maximum":58671.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36233.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36233.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57248.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36595.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":51648.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":51648.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":36595.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":46310.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51648.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":51648.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48528.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37682.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46662.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57248.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58671.47},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":36233.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36233.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34245.14,"maximum":55452.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34245.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34245.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":54107.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34587.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":48814.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":48814.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":34587.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":43769.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":48814.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":48814.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45865.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35614.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44101.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54107.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55452.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":34245.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34245.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33614.62,"maximum":54431.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53111.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":47915.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":47915.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":33950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":42963.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47915.57},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":47915.57},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45021.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34959.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43289.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53111.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54431.29},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":33614.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33614.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21398.97,"maximum":34650.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21398.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21398.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33810.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21612.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30502.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30502.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21612.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27350.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30502.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30502.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28660.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27558.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33810.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34650.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21398.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21398.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57276.12,"maximum":92745.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":90496.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57848.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":81643.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":81643.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":57848.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":73205.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81643.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":81643.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76712.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":59567.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":73761.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":90496.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92745.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":57276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57276.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41191.73,"maximum":66700.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41191.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41191.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":65082.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41603.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":58716.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":58716.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":41603.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":52647.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":58716.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":58716.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55169.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":42839.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53047.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65082.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66700.73},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":41191.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41191.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51944.55,"maximum":84112.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51944.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51944.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":82072.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52464.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":74043.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":74043.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":52464.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":66390.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":74043.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":74043.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69571.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":54022.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":66895.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":82072.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84112.49},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":51944.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51944.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37115.77,"maximum":60100.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37115.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37115.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58642.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37486.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":52906.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":52906.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37486.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47438.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52906.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":52906.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49710.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38600.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47798.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58642.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60100.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37115.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37115.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39873.62,"maximum":64566.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":63000.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40272.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":56837.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":56837.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":40272.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":50962.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56837.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":56837.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53404.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41468.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51350.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63000.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64566.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":39873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39873.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28460.39,"maximum":46085.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28460.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28460.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44967.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28744.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40568.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40568.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28744.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36375.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40568.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40568.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38118.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29598.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36652.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44967.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46085.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28460.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28460.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33440.0,"maximum":54148.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33440.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33440.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33774.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":47666.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":47666.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":33774.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":42740.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47666.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":47666.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44787.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34777.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43064.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54148.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":33440.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33440.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19367.44,"maximum":31361.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19367.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19367.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30600.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27607.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27607.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19561.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24753.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27607.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27607.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25939.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20142.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24941.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30600.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31361.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19367.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19367.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9406.17,"maximum":15231.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9406.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9406.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14861.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13407.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13407.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12022.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13407.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13407.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12598.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9782.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12113.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14861.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15231.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9406.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9406.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21693.16,"maximum":35127.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21693.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21693.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34275.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21910.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30922.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30922.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21910.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27726.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30922.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30922.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29054.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22560.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27937.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34275.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35127.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21693.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21693.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14478.19,"maximum":23444.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20637.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20637.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14622.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18504.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20637.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20637.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19391.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15057.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18645.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22875.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23444.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14478.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14478.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12280.88,"maximum":19886.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12403.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17505.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17505.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12403.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15696.33},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17505.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17505.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16448.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12772.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15815.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19886.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12280.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30998.77,"maximum":50195.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48978.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31308.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44186.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44186.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31308.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39619.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44186.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44186.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41517.84},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32238.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39921.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48978.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50195.52},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30998.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30998.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14828.78,"maximum":24011.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14828.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14828.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23429.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14977.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21137.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21137.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14977.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18952.83},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21137.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21137.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19860.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15421.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19096.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23429.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24011.86},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14828.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14828.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10154.23,"maximum":16442.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10154.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10154.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16043.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10255.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14474.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14474.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10255.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12978.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14474.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14474.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13599.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10560.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13076.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16043.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16442.49},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10154.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10154.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23700.91,"maximum":38378.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23700.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23700.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37447.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23937.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33784.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33784.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23937.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30292.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33784.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33784.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31743.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24648.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30522.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37447.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38378.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23700.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23700.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17635.55,"maximum":28556.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17635.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17635.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17811.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25138.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25138.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17811.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22540.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25138.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25138.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23619.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18340.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22711.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28556.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17635.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17635.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12105.58,"maximum":19602.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19126.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12226.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17255.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17255.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12226.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15472.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17255.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17255.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16213.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12589.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15589.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19126.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19602.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12105.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18327.22,"maximum":29676.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18327.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18327.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28957.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18510.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26124.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26124.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18510.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23424.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26124.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26124.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24546.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19060.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23602.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28957.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29676.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18327.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18327.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11536.21,"maximum":18680.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11536.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11536.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18227.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11651.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16444.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16444.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11651.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14744.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16444.16},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16444.16},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15450.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11997.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14856.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18227.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18680.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11536.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11536.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7420.84,"maximum":12016.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11724.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7495.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10577.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10577.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7495.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9484.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10577.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10577.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9939.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7717.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9556.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11724.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12016.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7420.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7420.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16606.87,"maximum":26891.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16606.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16606.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26238.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16772.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23672.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23672.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16772.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21225.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23672.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23672.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22242.22},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17271.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21386.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26238.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26891.09},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16606.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16606.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10886.67,"maximum":17628.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10886.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10886.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17200.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10995.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15518.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15518.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10995.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13914.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15518.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15518.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14580.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11322.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14020.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17200.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17628.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10886.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10886.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31230.46,"maximum":50570.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31230.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31230.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31542.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44517.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44517.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31542.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39916.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44517.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44517.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41828.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40219.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49344.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50570.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31230.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31230.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16287.54,"maximum":26373.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16287.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16287.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25734.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16450.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23216.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23216.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16450.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20817.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23216.88},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23216.88},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21814.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16939.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20975.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25734.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26373.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16287.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16287.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11434.3,"maximum":18515.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11434.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11434.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18066.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11548.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16298.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16298.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11548.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14614.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16298.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16298.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15314.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11891.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14725.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18066.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18515.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11434.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11434.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24600.49,"maximum":39834.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24600.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24600.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24846.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35066.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35066.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24846.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31442.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35066.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35066.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32948.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25584.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31681.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38868.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39834.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24600.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24600.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15913.85,"maximum":25768.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15913.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15913.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22684.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22684.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16072.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20339.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22684.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22684.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21314.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16550.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20494.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25768.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15913.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15913.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11128.55,"maximum":18020.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17583.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11239.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15863.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15863.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11239.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14223.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15863.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15863.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14904.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11573.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14331.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17583.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18020.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11128.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24262.13,"maximum":39287.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24262.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24262.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38334.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24504.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34584.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34584.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24504.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31009.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34584.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34584.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32495.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25232.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31245.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38334.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39287.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24262.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24262.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14327.35,"maximum":23199.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14470.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20422.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20422.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14470.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18311.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20422.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20422.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19189.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14900.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18451.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23199.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14327.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14327.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10429.41,"maximum":16888.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10429.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10429.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16478.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14866.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14866.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13329.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14866.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14866.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13968.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10846.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13431.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16478.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16888.07},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10429.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10429.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17548.58,"maximum":28415.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17548.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17548.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27726.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17724.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25014.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25014.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17724.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22429.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25014.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25014.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23503.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22599.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27726.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28415.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17548.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17548.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10223.53,"maximum":16554.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10223.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10223.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16153.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10325.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14573.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14573.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10325.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13066.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14573.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14573.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13692.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10632.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13166.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16153.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16554.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10223.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10223.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8059.52,"maximum":13050.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8059.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8059.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12734.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8140.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11488.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11488.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8140.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10300.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11488.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11488.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10794.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8381.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10379.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12734.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13050.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8059.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8059.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15597.23,"maximum":25256.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22232.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22232.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15753.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19934.99},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22232.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22232.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20889.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16221.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20086.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24643.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25256.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15597.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15597.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8892.51,"maximum":14399.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8892.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8892.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14050.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8981.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12675.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12675.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8981.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11365.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12675.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12675.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11910.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9248.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11452.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14050.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14399.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8892.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8892.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5915.21,"maximum":9578.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9346.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5974.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8431.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8431.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5974.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7560.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8431.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8431.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7922.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6151.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7617.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9346.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9578.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5915.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5915.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16930.97,"maximum":27415.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16930.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16930.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26750.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24134.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24134.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21639.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24134.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24134.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22676.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17608.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21804.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26750.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27415.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16930.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16930.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10358.06,"maximum":16772.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16365.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10461.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14764.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14764.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10461.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13238.76},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14764.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14764.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13872.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10772.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13339.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16365.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16772.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10358.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7934.5,"maximum":12848.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12536.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8013.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11310.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11310.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8013.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10141.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11310.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11310.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10626.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8251.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10218.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12536.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12848.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7934.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19717.35,"maximum":31927.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31153.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19914.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28105.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28105.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19914.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25200.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28105.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28105.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26408.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20506.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25392.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31153.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31927.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19717.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11430.9,"maximum":18509.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11430.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11430.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16294.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16294.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14609.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16294.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16294.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15309.84},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11888.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14721.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18509.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11430.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11430.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9138.47,"maximum":14797.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9229.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13026.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13026.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9229.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11679.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13026.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13026.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12239.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9504.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11768.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14797.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9138.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29846.44,"maximum":48329.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29846.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29846.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47157.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":42544.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":42544.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":30144.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":38147.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":42544.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":42544.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39974.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31040.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38437.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47157.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48329.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":29846.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29846.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15800.38,"maximum":25585.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15800.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15800.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24964.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15958.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22522.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22522.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15958.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20194.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22522.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22522.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21162.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16432.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20348.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24964.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25585.15},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15800.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15800.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14000.54,"maximum":22670.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22120.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14140.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19956.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19956.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14140.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17894.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19956.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19956.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18751.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14560.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18030.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22120.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22670.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14000.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9977.58,"maximum":16156.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9977.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9977.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10077.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14222.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14222.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10077.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12752.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14222.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14222.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13363.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10376.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12849.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15764.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16156.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9977.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9977.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24342.98,"maximum":39417.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24342.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24342.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38461.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24586.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34699.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34699.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24586.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31113.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34699.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34699.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32603.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25316.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31349.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38461.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39417.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24342.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24342.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12295.15,"maximum":19909.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12418.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17525.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17525.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12418.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15714.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17525.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17525.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16467.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12786.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15834.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19909.22},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9689.5,"maximum":15689.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15309.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9786.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13811.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13811.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9786.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12384.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13811.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13811.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12977.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10077.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12478.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15309.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15689.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9689.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12466.37,"maximum":20186.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12466.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12466.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19696.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12591.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17770.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17770.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12591.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15933.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17770.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17770.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16696.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12965.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16054.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19696.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20186.47},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12466.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12466.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8429.81,"maximum":13650.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8429.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8429.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13319.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8514.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12016.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12016.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8514.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10774.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12016.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12016.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11290.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8767.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10856.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13319.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13650.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8429.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8429.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13922.41,"maximum":22544.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21997.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14061.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19845.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19845.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14061.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17794.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19845.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19845.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18646.81},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17929.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21997.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22544.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13922.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7728.63,"maximum":12514.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7728.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7728.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12211.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7805.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11016.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11016.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7805.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9878.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11016.69},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11016.69},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10351.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8037.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9953.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12211.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12514.78},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7728.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7728.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11802.55,"maximum":19111.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11802.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11802.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18648.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11920.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16823.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16823.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11920.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15084.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16823.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16823.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15807.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12274.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15199.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18648.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19111.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11802.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11802.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5841.15,"maximum":9458.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5841.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5841.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9229.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5899.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8326.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8326.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5899.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7465.63},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8326.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8326.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7823.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6074.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7522.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9229.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9458.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5841.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5841.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9425.87,"maximum":15263.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9425.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9425.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14892.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9520.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13436.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13436.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9520.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12047.31},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13436.0},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13436.0},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12624.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9802.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12138.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14892.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15263.07},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9425.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9425.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9497.89,"maximum":15379.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9497.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9497.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15006.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9592.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13538.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13538.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9592.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12139.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13538.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13538.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12720.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9877.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12231.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15006.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15379.7},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9497.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9497.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23363.23,"maximum":37831.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23363.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23363.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36913.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23596.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33302.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33302.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23596.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29860.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33302.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33302.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31291.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24297.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30087.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36913.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37831.48},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23363.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23363.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16403.72,"maximum":26562.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16403.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16403.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25917.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16567.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23382.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23382.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16567.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20965.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23382.5},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23382.5},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21970.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17059.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21125.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25917.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26562.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16403.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16403.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10816.01,"maximum":17514.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10816.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10816.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17089.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10924.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15417.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15417.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10924.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13824.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15417.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15417.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14486.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13929.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17089.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17514.08},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10816.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10816.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6795.76,"maximum":11004.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6795.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6795.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10737.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6863.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9686.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9686.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6863.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8685.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9686.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9686.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9101.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7067.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8751.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10737.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11004.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6795.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6795.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4761.52,"maximum":7710.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7523.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4809.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6787.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6787.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4809.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6085.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6787.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6787.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6377.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4951.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6132.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7523.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7710.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4761.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12047.15,"maximum":19507.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12047.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12047.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19034.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17172.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17172.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12167.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15397.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17172.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17172.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16135.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12529.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15514.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19034.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19507.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12047.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12047.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6937.08,"maximum":11233.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10960.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7006.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9888.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9888.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7006.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8866.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9888.38},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9888.38},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9291.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7214.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8933.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10960.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11233.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6937.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4942.25,"maximum":8002.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4942.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4942.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4991.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7044.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7044.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4991.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6316.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7044.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7044.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6619.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5139.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6364.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7808.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8002.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4942.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4942.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14531.19,"maximum":23529.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14531.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14531.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20713.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20713.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18572.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20713.31},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20713.31},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19462.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15112.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18713.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23529.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14531.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14531.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8218.51,"maximum":13308.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8218.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8218.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12985.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8300.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11714.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11714.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8300.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10504.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11714.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11714.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11007.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8547.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10584.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12985.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13308.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8218.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8218.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6280.06,"maximum":10169.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6280.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6280.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6342.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8951.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8951.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6342.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8026.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8951.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8951.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8411.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6531.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8087.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10169.15},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6280.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6280.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12420.16,"maximum":20111.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12420.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12420.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19623.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12544.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17704.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17704.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12544.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15874.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17704.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17704.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16634.8},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12916.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15995.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19623.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20111.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12420.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12420.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6663.27,"maximum":10789.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6663.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6663.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10527.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6729.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9498.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9498.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6729.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8516.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9498.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9498.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8924.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6929.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8581.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10527.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10789.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6663.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6663.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4283.19,"maximum":6935.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4326.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6105.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6105.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4326.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5474.39},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6105.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6105.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5736.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4454.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5516.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6767.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6935.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4283.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13331.97,"maximum":21588.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21064.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13465.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19003.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19003.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13465.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17039.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19003.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19003.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17856.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13865.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17169.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21064.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21588.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13331.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13331.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7361.73,"maximum":11920.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7435.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10493.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10493.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7435.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9409.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10493.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10493.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9859.85},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7656.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9480.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11631.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11920.67},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7361.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7361.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5439.6,"maximum":8808.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5439.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5439.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8594.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5494.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7753.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7753.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5494.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6952.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7753.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7753.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7285.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5657.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7005.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8594.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8808.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5439.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5439.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9381.03,"maximum":15190.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14822.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9474.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13372.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13372.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9474.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11990.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13372.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13372.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12564.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9756.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12081.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14822.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15190.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9381.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5807.85,"maximum":9404.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5807.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5807.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9176.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5865.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8278.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8278.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5865.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7423.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8278.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8278.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7778.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6040.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7479.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9176.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9404.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5807.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5807.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10750.78,"maximum":17408.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16986.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10858.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15324.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15324.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10858.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13740.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15324.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15324.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14398.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11180.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13845.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16986.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17408.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10750.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6633.37,"maximum":10741.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6633.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6633.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10480.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6699.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9455.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9455.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6699.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8478.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9455.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9455.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8884.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8542.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10480.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10741.25},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6633.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6633.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4629.03,"maximum":7495.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4629.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4629.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7313.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6598.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6598.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5916.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6598.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6598.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6199.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4814.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5961.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7313.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7495.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4629.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4629.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10033.97,"maximum":16247.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10033.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10033.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10134.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14302.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14302.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10134.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12824.53},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14302.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14302.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13438.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10435.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12922.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16247.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10033.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10033.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5366.22,"maximum":8689.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5419.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7649.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7649.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5419.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6858.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7649.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7649.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7187.18},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5580.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6910.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8478.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8689.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5366.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3696.15,"maximum":5985.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3696.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3696.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5839.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3733.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5268.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5268.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3733.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4724.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5268.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5268.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4950.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3844.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4760.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5839.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5985.09},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3696.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3696.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8617.34,"maximum":13953.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8617.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8617.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13615.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8703.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12283.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12283.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8703.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11013.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12283.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12283.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11541.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8962.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11097.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13615.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13953.84},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8617.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8617.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5296.91,"maximum":8577.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5296.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5296.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8369.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5349.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7550.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7550.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5349.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6770.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7550.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7550.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7094.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5508.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6821.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8369.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8577.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5296.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5296.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":215.86,"10th_percentile":215.86,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10866.29,"maximum":17595.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10866.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10866.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17168.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15489.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15489.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10974.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13888.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15489.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15489.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14553.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11300.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13993.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17168.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17595.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10866.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10866.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6357.52,"maximum":10294.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10044.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9062.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9062.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8125.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9062.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9062.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8514.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6611.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8187.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10044.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10294.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6357.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4409.57,"maximum":7140.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6967.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4453.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6285.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6285.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4453.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5635.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6285.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6285.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5905.9},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5678.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6967.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7140.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4409.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16271.91,"maximum":26348.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16271.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16271.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16434.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23194.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23194.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16434.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20797.31},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23194.61},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23194.61},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21793.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16922.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20955.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26348.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16271.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16271.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10284.01,"maximum":16652.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10284.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10284.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16248.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14659.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14659.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13144.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14659.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14659.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13773.76},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13244.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16248.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16652.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10284.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10284.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7777.55,"maximum":12593.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7777.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7777.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12288.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11086.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11086.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7855.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9940.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11086.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11086.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10416.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8088.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10016.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12288.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12593.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7777.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7777.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27316.89,"maximum":44233.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27316.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27316.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43160.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27590.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":38938.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":38938.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":27590.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":34914.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38938.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":38938.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36586.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35179.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43160.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44233.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":27316.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27316.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37168.77,"maximum":60186.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37168.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37168.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58726.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37540.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":52981.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":52981.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37540.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47505.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52981.79},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":52981.79},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49781.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38655.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47866.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58726.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60186.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37168.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37168.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19705.12,"maximum":31908.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31134.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28088.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28088.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25185.34},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28088.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28088.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26391.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20493.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25376.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31134.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31908.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19705.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15080.85,"maximum":24420.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15080.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15080.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23827.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15231.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21496.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21496.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15231.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19275.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21496.83},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21496.83},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20198.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15684.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19421.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23827.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24420.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15080.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15080.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24226.12,"maximum":39228.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38277.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24468.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34532.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34532.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24468.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30963.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34532.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34532.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32446.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25195.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31199.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38277.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39228.73},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24226.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14793.45,"maximum":23954.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14793.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14793.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23373.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14941.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21087.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21087.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14941.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18907.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21087.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21087.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19813.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15385.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19051.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23373.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23954.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14793.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14793.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10787.47,"maximum":17467.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10787.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10787.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17044.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10895.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15376.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15376.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10895.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13787.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15376.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15376.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14448.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11218.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13892.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17044.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17467.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10787.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10787.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22443.94,"maximum":36342.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22443.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22443.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35461.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22668.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31992.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31992.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22668.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28685.86},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31992.46},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31992.46},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30060.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23341.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28903.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35461.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36342.91},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22443.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22443.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14285.23,"maximum":23131.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14285.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14285.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22570.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14428.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20362.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20362.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14428.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18258.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20362.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20362.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19132.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14856.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18396.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22570.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23131.7},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14285.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14285.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11282.1,"maximum":18268.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11282.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11282.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17825.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11394.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16081.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16081.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11394.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14419.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16081.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16081.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15110.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11733.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14529.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17825.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18268.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11282.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11282.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24205.73,"maximum":39195.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38245.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24447.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34503.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34503.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24447.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30937.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34503.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34503.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32419.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25173.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31172.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38245.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39195.73},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24205.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24205.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14041.99,"maximum":22737.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14041.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14041.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22186.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14182.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20015.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20015.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14182.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17947.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20015.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20015.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18806.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14603.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18083.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22186.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22737.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14041.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14041.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9262.81,"maximum":14999.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9262.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9262.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14635.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13203.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13203.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9355.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11838.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13203.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13203.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12406.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9633.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11928.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14635.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14999.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9262.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9262.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16214.16,"maximum":26255.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25618.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16376.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23112.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23112.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16376.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20723.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23112.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23112.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21716.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16862.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20881.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25618.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26255.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16214.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11493.41,"maximum":18610.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18159.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11608.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16383.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16383.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11608.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14689.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16383.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16383.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15393.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11953.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14801.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18159.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18610.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11493.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9279.79,"maximum":15026.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9279.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9279.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14662.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9372.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13227.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13227.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9372.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11860.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13227.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13227.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12428.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9650.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11950.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14662.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15026.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9279.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9279.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23149.2,"maximum":37484.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23380.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":32997.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":32997.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23380.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29587.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":32997.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":32997.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31004.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24075.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29812.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36575.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37484.91},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23149.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11805.27,"maximum":19115.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11805.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11805.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11923.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16827.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16827.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11923.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15088.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16827.69},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16827.69},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15811.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12277.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15203.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18652.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19115.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11805.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11805.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9508.76,"maximum":15397.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15023.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9603.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13554.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13554.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9603.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12153.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13554.16},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13554.16},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12735.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9889.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12245.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15023.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15397.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9508.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28217.15,"maximum":45691.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44583.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28499.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40221.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40221.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28499.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36064.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40221.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40221.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37792.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29345.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36338.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44583.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45691.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28217.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14865.47,"maximum":24071.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15014.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21189.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21189.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15014.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18999.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21189.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21189.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19909.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15460.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19144.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24071.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14865.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14865.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10193.64,"maximum":16506.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10193.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10193.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16105.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10295.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14530.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14530.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10295.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13028.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14530.41},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14530.41},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13652.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10601.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13127.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16105.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16506.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10193.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10193.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74882.45,"maximum":121255.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":74882.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":74882.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":118314.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":75631.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":106740.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":106740.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":75631.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":95708.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":106740.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":106740.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":100292.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":77877.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":96435.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":118314.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":121255.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":74882.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":74882.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49046.06,"maximum":79419.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":49046.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":49046.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":77492.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49536.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":69912.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":69912.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":49536.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":62686.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69912.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":69912.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65689.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51007.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":63162.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":77492.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":79419.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":49046.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":49046.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38198.12,"maximum":61853.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60353.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":54449.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":54449.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":38580.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":48821.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":54449.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":54449.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51160.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39726.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49192.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60353.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61853.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":38198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38198.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61214.83,"maximum":99123.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":61214.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":61214.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":96719.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":61826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":87257.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":87257.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":61826.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":78239.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":87257.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":87257.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":81987.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":63663.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":78834.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":96719.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":99123.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":61214.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":61214.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39183.99,"maximum":63449.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":61910.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39575.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":55854.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":55854.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":39575.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":50081.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55854.36},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":55854.36},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52480.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40751.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50462.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61910.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63449.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":39183.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39183.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13372.74,"maximum":21654.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13372.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13372.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21128.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13506.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19062.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19062.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13506.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17091.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19062.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19062.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17910.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13907.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17221.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21128.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21654.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13372.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13372.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7176.25,"maximum":11620.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7176.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7176.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11338.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7248.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10229.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10229.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7248.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9172.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10229.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10229.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9611.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7463.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9241.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11338.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11620.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7176.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7176.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":107.15,"10th_percentile":107.15,"90th_percentile":107.15,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4841.01,"maximum":7838.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4841.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4841.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6900.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6900.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6187.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6900.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6900.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6483.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5034.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6234.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7648.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7838.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4841.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4841.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12479.28,"maximum":20207.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12479.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12479.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19717.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12604.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17788.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17788.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12604.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15949.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17788.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17788.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16713.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12978.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16071.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19717.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20207.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12479.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12479.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7685.15,"maximum":12444.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7685.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7685.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12142.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7762.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10954.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10954.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7762.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9822.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10954.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10954.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10293.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7992.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9897.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12142.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12444.36},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7685.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7685.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5797.66,"maximum":9388.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5797.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5797.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9160.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5855.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8264.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8264.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5855.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7410.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8264.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8264.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7765.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6029.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7466.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9160.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9388.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5797.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5797.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11076.23,"maximum":17935.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11076.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11076.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17500.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15788.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15788.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11186.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14156.66},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15788.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15788.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14834.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11519.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14264.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17500.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17935.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11076.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11076.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5715.45,"maximum":9254.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8147.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8147.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5772.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7304.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8147.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8147.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7654.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5944.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7360.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9254.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5715.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5715.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":158.51,"10th_percentile":158.51,"90th_percentile":158.51,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4222.04,"maximum":6836.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4264.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6018.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6018.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4264.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5396.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6018.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6018.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5654.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5437.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6670.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6836.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4222.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12193.91,"maximum":19745.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19266.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12315.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17381.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17381.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12315.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15585.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17381.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17381.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16331.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12681.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15703.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19266.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19745.29},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12193.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11877.29,"maximum":19232.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11877.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11877.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18766.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11996.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16930.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16930.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11996.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15180.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16930.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16930.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15907.71},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12352.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15295.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18766.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19232.6},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11877.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11877.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9144.58,"maximum":14807.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9144.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9144.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14448.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9236.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13035.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13035.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9236.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11687.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13035.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13035.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12247.69},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9510.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11776.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14448.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14807.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9144.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9144.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18963.85,"maximum":30707.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18963.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18963.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29962.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19153.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27031.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27031.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19153.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24237.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27031.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27031.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25399.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19722.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24422.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29962.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30707.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18963.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18963.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12700.09,"maximum":20564.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12700.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12700.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12827.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18103.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18103.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12827.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16232.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18103.2},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18103.2},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17009.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13208.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16355.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20066.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20564.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12700.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12700.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12181.0,"maximum":19724.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12181.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12181.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19245.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12302.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17363.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17363.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12302.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15568.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17363.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17363.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16314.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12668.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15687.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19245.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19724.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12181.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12181.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9167.01,"maximum":14843.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9167.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9167.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14483.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9258.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13067.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13067.0},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9258.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11716.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13067.0},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13067.0},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12277.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9533.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11805.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14483.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14843.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9167.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9167.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12273.41,"maximum":19874.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12273.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12273.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19391.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17494.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17494.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15686.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17494.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17494.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16438.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12764.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15806.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19391.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19874.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12273.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12273.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10289.44,"maximum":16661.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10289.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10289.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16257.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10392.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14666.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14666.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10392.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13151.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14666.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14666.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13781.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10701.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13251.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16257.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16661.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10289.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10289.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20522.49,"maximum":33231.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32425.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20727.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29253.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29253.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20727.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26230.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29253.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29253.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27486.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21343.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26429.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32425.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33231.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20522.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14128.28,"maximum":22877.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14128.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14128.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14269.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20138.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20138.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14269.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18057.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20138.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20138.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18922.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14693.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18194.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22877.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14128.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14128.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11247.45,"maximum":18212.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11247.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11247.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17770.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11359.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16032.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16032.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11359.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14375.49},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16032.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16032.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15064.14},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11697.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14484.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17770.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18212.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11247.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11247.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10696.43,"maximum":17320.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10696.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10696.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16900.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10803.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15247.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15247.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10803.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13671.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15247.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15247.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14326.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11124.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13775.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16900.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17320.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10696.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10696.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6945.92,"maximum":11247.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10974.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7015.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9900.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9900.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7015.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8877.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9900.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9900.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9302.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7223.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8945.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10974.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11247.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6945.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6945.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21653.08,"maximum":35062.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34211.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21869.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30865.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30865.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21869.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27675.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30865.13},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30865.13},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29000.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22519.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27885.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34211.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35062.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21653.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21653.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14119.44,"maximum":22863.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14119.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14119.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22308.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14260.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20126.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20126.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14260.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18046.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20126.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20126.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18910.71},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14684.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18183.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22308.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22863.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14119.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14119.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10440.96,"maximum":16906.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10440.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10440.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16496.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10545.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14882.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14882.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10545.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13344.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14882.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14882.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13983.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10858.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13446.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16496.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16906.77},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10440.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10440.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25392.71,"maximum":41117.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25392.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25392.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40120.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":36195.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":36195.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25646.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32454.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36195.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":36195.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34009.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26408.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32701.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40120.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41117.77},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25392.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25392.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13590.16,"maximum":22006.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21472.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13726.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19371.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19371.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13726.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17369.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19371.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19371.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18201.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14133.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17501.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21472.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22006.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13590.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10150.16,"maximum":16435.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10150.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10150.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16037.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10251.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14468.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14468.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10251.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12973.03},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14468.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14468.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13594.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10556.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13071.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16037.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16435.89},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10150.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10150.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19501.29,"maximum":31577.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19501.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19501.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30812.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19696.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27797.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27797.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19696.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24924.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27797.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27797.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26118.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20281.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25114.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30812.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31577.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19501.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19501.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14388.5,"maximum":23298.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14388.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14388.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22733.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14532.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20509.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20509.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14532.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18390.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20509.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20509.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19271.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14964.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18529.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22733.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23298.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14388.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14388.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10651.58,"maximum":17247.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10651.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10651.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16829.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10758.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15183.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15183.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10758.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13613.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15183.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15183.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14266.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11077.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13717.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16829.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17247.84},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10651.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10651.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5476.97,"maximum":8868.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5476.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5476.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8653.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5531.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7807.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7807.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5531.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7000.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7807.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7807.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7335.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5696.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7053.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8653.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8868.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5476.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5476.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8710.42,"maximum":14104.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8710.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8710.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13762.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12416.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12416.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11132.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12416.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12416.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11666.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9058.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11217.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13762.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14104.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8710.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8710.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5487.16,"maximum":8885.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5487.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5487.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8669.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5542.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7821.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7821.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5542.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7013.2},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7821.61},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7821.61},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7349.16},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5706.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7066.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8669.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8885.22},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5487.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5487.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6483.9,"maximum":10499.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10244.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6548.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9242.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9242.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6548.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8287.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9242.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9242.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8684.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6743.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8350.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10244.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10499.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6483.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4894.01,"maximum":7924.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4894.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4894.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7732.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4942.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6976.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6976.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4942.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6255.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6976.11},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6976.11},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6554.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5089.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6302.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7732.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7924.74},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4894.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4894.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13382.93,"maximum":21670.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13382.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13382.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21145.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13516.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19076.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19076.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13516.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17104.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19076.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19076.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17924.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13918.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17234.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21145.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21670.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13382.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13382.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8807.58,"maximum":14261.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13915.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8895.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8895.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11257.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11796.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9159.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11342.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13915.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14261.89},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5349.91,"maximum":8662.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5349.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5349.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8452.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5403.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7625.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7625.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5403.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6837.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7625.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7625.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7165.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5563.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6889.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8452.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8662.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5349.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5349.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12002.31,"maximum":19435.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18963.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12122.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17108.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17108.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12122.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15340.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17108.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17108.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16075.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12482.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15456.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18963.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19435.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12002.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6984.64,"maximum":11310.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6984.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6984.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11035.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7054.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9956.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9956.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7054.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8927.15},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9956.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9956.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9354.8},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7264.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8995.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11035.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11310.06},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6984.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6984.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5127.05,"maximum":8302.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5127.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5127.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8100.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5178.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7308.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7308.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5178.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6552.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7308.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7308.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6866.86},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5332.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6602.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8100.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8302.11},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5127.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5127.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16861.66,"maximum":27303.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16861.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16861.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26641.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17030.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24035.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24035.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17030.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21551.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24035.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24035.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22583.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17536.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21714.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26641.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27303.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16861.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16861.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7836.66,"maximum":12689.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7836.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7836.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12381.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7915.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11170.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11170.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7915.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10016.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11170.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11170.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10495.94},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8150.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10092.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12381.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12689.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7836.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7836.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5681.48,"maximum":9199.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5681.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5681.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8976.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8098.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8098.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7261.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8098.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8098.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7609.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5908.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7316.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8976.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9199.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5681.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5681.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13119.31,"maximum":21243.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20728.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13250.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16767.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18700.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17571.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13644.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16895.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20728.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21243.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13119.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8202.2,"maximum":13281.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8202.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8202.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12959.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8284.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11691.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11691.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8284.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10483.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11691.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11691.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10985.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8530.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10563.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12959.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13281.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8202.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8202.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5938.99,"maximum":9616.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5938.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5938.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9383.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5998.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8465.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8465.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5998.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7590.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8465.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8465.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7954.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6176.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7648.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9383.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9616.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5938.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5938.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11388.1,"maximum":18440.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11388.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11388.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17993.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11501.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16233.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16233.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11501.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14555.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16233.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16233.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15252.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11843.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14665.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17993.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18440.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11388.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11388.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6531.46,"maximum":10576.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10319.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6596.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9310.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9310.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6596.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8347.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9310.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9310.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8747.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6792.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8411.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10319.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10576.22},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6531.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8807.58,"maximum":14261.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13915.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8895.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8895.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11257.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12554.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11796.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9159.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11342.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13915.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14261.89},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8807.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5640.03,"maximum":9132.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5640.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5640.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8911.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5696.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8039.52},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8039.52},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5696.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7208.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8039.52},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8039.52},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7553.91},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5865.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7263.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8911.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9132.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5640.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5640.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8980.84,"maximum":14542.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14189.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9070.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12801.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12801.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9070.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11478.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12801.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12801.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12028.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9340.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11565.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14189.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14542.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8980.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5643.43,"maximum":9138.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5643.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5643.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8916.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8044.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8044.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5699.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7212.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8044.36},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8044.36},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7558.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5869.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7267.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8916.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9138.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5643.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5643.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10102.59,"maximum":16358.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10102.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10102.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15962.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10203.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14400.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14400.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10203.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12912.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14400.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14400.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13530.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10506.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13010.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15962.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16358.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10102.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10102.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6068.76,"maximum":9826.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6068.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6068.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9588.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6129.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8650.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8650.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6129.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7756.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8650.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8650.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8128.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6311.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7815.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9588.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9826.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6068.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6068.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12670.88,"maximum":20517.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12670.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12670.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20019.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12797.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18061.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18061.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12797.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16194.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18061.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18061.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16970.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16317.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20019.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20517.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12670.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12670.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7651.17,"maximum":12389.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12088.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10906.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10906.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7727.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9779.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10906.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10906.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10247.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7957.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9853.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12088.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12389.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7651.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7651.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5462.02,"maximum":8844.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8629.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5516.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7785.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7785.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5516.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6981.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7785.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7785.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7315.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5680.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7034.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8629.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8844.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5462.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9680.66,"maximum":15675.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9680.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9680.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15295.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9777.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13799.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13799.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9777.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12372.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13799.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13799.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12965.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10067.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12467.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15295.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15675.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9680.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9680.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6084.39,"maximum":9852.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9613.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6145.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8672.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8672.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6145.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7776.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8672.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8672.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8149.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6327.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7835.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9613.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9852.29},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6084.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10487.84,"maximum":16982.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10487.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10487.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16570.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10592.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14949.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14949.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10592.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13404.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14949.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14949.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14046.76},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10907.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13506.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16570.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16982.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10487.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10487.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13590.84,"maximum":22007.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21473.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13726.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19372.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19372.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13726.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17370.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19372.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19372.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18202.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14134.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17502.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21473.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22007.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13590.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10423.97,"maximum":16879.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10423.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10423.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10528.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14858.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14858.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10528.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13322.99},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14858.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14858.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13961.22},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10840.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13424.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16469.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16879.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10423.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10423.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15811.25,"maximum":25602.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24981.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15969.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22537.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22537.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15969.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20208.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22537.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22537.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21176.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16443.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20362.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24981.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25602.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15811.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15811.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9520.31,"maximum":15416.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9520.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9520.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15042.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13570.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13570.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9615.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12168.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13570.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13570.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12750.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9901.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12260.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15042.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15416.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9520.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9520.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14158.17,"maximum":22925.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14158.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14158.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14299.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20181.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20181.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14299.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18095.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20181.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20181.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18962.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14724.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18233.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22925.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14158.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14158.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7471.8,"maximum":12098.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7471.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7471.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11805.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7546.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10650.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10650.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7546.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9549.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10650.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10650.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10007.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7770.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9622.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11805.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12098.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7471.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7471.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10214.7,"maximum":16540.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16139.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10316.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14560.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14560.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10316.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13055.53},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14560.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14560.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13680.94},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10623.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13154.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16139.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16540.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10214.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7184.4,"maximum":11633.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7184.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7184.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7256.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10240.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10240.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7256.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9182.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10240.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10240.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9622.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7471.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9252.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11351.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11633.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7184.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7184.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15201.11,"maximum":24614.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15201.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15201.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24017.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15353.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21668.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21668.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15353.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19428.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21668.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21668.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20359.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15809.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19576.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24017.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24614.77},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15201.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15201.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9994.56,"maximum":16183.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9994.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9994.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15791.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14246.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14246.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10094.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12774.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14246.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14246.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13386.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10394.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12871.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15791.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16183.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9994.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9994.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12844.81,"maximum":20799.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20294.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16417.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18309.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17203.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13358.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16541.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20294.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20799.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12844.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9125.56,"maximum":14776.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14418.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9216.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13007.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13007.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9216.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11663.48},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13007.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13007.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12222.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9490.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11752.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14418.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14776.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9125.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9125.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12295.83,"maximum":19910.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19427.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17526.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17526.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12418.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15715.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17526.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17526.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16468.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12787.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15834.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19427.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19910.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12295.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7763.96,"maximum":12571.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7763.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7763.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12267.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7841.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11067.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11067.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7841.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9923.21},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11067.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11067.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10398.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8074.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9998.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12267.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12571.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7763.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7763.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4455.09,"maximum":7214.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4455.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4455.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7039.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4499.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6350.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6350.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4499.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5694.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6350.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6350.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5966.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4633.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5737.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7039.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7214.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4455.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4455.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7950.81,"maximum":12874.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12562.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8030.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11333.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11333.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8030.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10162.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11333.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11333.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10648.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8268.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10239.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12562.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12874.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7950.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4905.56,"maximum":7943.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4905.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4905.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4954.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6992.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6992.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4954.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6269.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6992.57},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6992.57},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6570.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5101.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6317.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7750.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7943.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4905.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4905.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10075.42,"maximum":16314.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10075.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10075.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10176.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14361.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14361.89},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10176.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12877.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14361.89},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14361.89},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13494.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10478.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12975.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16314.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10075.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10075.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5511.62,"maximum":8924.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5511.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5511.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8708.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5566.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7856.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7856.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5566.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7044.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7856.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7856.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7381.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5732.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7098.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8708.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8924.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5511.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5511.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7193.23,"maximum":11647.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7193.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7193.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11365.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7265.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10253.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10253.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7265.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9193.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10253.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10253.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9634.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7480.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9263.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11365.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11647.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7193.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7193.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4565.84,"maximum":7393.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4565.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4565.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7214.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4611.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6508.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6508.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4611.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5835.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6508.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6508.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6115.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4748.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5880.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7214.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7393.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4565.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4565.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14472.07,"maximum":23434.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14472.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14472.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22865.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20629.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20629.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14616.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18496.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20629.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20629.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19383.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15050.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18637.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22865.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23434.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14472.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14472.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9141.87,"maximum":14803.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9141.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9141.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14444.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9233.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13031.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13031.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9233.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11684.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13031.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13031.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12244.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9507.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11773.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14444.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14803.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9141.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9141.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24286.59,"maximum":39326.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24286.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24286.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24529.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34619.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34619.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24529.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31040.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34619.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34619.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32527.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25258.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31276.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38372.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39326.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24286.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24286.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6620.46,"maximum":10720.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6620.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6620.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10460.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6686.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9437.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9437.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6686.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8461.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9437.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9437.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8867.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6885.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8526.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10460.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10720.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6620.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6620.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5091.04,"maximum":8243.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5091.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5091.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8043.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5141.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7256.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7256.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5141.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6506.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7256.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7256.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6818.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5294.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6556.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8043.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8243.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5091.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5091.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19983.01,"maximum":32357.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31573.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20182.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28484.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28484.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20182.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25540.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28484.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28484.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26764.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25734.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31573.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32357.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19983.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11479.14,"maximum":18587.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11479.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11479.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18137.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11593.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16362.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16362.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11593.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14671.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16362.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16362.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15374.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11938.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14783.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18137.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18587.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11479.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11479.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7788.42,"maximum":12611.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7788.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7788.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12305.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11101.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11101.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7866.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9954.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11101.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11101.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10431.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8099.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10030.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12305.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12611.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7788.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7788.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44512.84,"maximum":72078.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44512.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44512.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":70330.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":63450.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":63450.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":44957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":56892.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":63450.31},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":63450.31},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59617.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46293.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57324.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70330.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72078.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":44512.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":44512.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23586.08,"maximum":38192.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23586.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23586.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37266.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33620.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33620.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30145.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33620.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33620.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31589.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24529.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30374.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37266.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38192.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23586.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23586.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12209.54,"maximum":19770.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12209.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12209.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19291.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12331.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17403.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17403.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12331.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15605.15},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17403.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17403.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16352.7},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12697.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15723.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19291.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19770.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12209.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12209.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33300.72,"maximum":53923.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33300.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33300.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33633.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":47468.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":47468.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":33633.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":42562.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47468.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":47468.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44600.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34632.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42885.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52615.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53923.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":33300.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33300.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18009.92,"maximum":29163.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28455.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18190.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25672.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25672.03},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18190.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23018.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25672.03},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25672.03},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24121.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18730.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23193.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28455.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29163.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18009.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18009.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10914.53,"maximum":17673.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10914.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10914.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17244.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11023.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15557.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15557.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11023.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13949.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15557.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15557.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14618.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11351.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14056.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17244.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17673.61},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10914.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10914.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22003.67,"maximum":35629.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34765.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22223.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31364.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31364.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22223.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28123.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31364.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31364.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29470.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22883.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28336.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34765.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35629.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":22003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22003.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11740.72,"maximum":19011.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11740.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11740.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18550.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11858.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16735.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16735.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11858.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15005.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16735.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16735.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15724.8},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12210.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15120.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18550.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19011.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11740.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11740.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9805.0,"maximum":15876.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9805.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9805.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15491.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13976.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13976.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12531.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13976.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13976.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13132.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10197.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12627.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15491.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15876.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9805.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9805.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13090.09,"maximum":21196.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13090.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13090.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20682.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18659.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18659.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13220.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16730.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18659.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18659.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17532.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13613.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16857.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20682.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21196.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13090.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13090.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11716.26,"maximum":18971.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11716.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11716.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18511.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16700.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16700.81},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14974.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16700.81},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16700.81},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15692.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12184.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15088.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18511.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18971.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11716.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11716.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14544.77,"maximum":23551.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14544.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14544.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14690.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20732.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20732.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14690.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18589.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20732.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20732.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19480.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15126.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18731.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23551.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14544.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14544.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13107.08,"maximum":21223.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13107.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13107.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20709.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13238.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18683.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18683.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13238.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16752.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18683.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18683.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17554.81},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13631.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16879.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20709.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21223.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13107.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13107.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13149.2,"maximum":21292.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20775.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13280.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18743.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18743.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13280.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16806.15},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18743.38},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18743.38},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17611.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13675.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16933.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20775.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21292.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13149.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13149.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8060.2,"maximum":13051.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8060.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8060.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12735.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8140.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11489.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11489.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8140.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10301.83},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11489.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11489.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10795.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8382.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10380.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12735.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13051.67},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8060.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8060.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5889.39,"maximum":9536.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5948.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8394.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8394.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5948.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7527.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8394.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8394.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7887.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6124.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7584.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9536.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5889.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14408.89,"maximum":23331.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14408.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14408.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22766.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14552.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20538.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20538.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14552.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18416.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20538.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20538.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19298.37},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14985.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18556.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22766.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23331.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14408.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14408.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7354.94,"maximum":11909.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7354.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7354.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11620.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7428.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10484.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10484.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7428.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9400.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10484.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10484.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9850.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7649.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9471.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11620.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11909.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7354.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7354.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11326.95,"maximum":18341.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17896.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11440.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16145.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16145.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11440.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14477.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16145.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16145.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15170.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11780.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14587.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17896.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18341.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11326.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7686.51,"maximum":12446.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12144.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7763.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10956.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10956.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7763.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9824.21},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10956.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10956.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10294.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7993.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9898.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12144.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12446.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7686.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5227.61,"maximum":8464.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5227.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5227.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8259.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5279.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7451.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7451.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5279.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6681.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7451.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7451.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7001.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5436.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6732.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8259.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8464.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5227.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5227.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7077.05,"maximum":11459.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7077.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7077.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7147.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10087.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10087.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7147.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9045.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10087.9},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10087.9},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9478.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7360.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9114.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11181.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11459.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7077.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7077.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4110.61,"maximum":6656.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4110.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4110.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6494.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4151.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5859.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5859.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4151.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5253.82},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5859.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5859.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5505.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5293.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6494.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6656.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4110.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4110.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9656.88,"maximum":15637.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9656.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9656.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15257.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9753.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13765.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13765.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9753.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12342.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13765.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13765.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12933.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10043.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12436.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15257.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15637.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9656.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9656.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5917.24,"maximum":9581.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5917.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5917.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9349.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5976.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8434.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8434.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5976.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7562.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8434.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8434.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7925.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6153.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7620.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9349.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9581.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5917.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5917.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":107.15,"10th_percentile":107.15,"90th_percentile":107.15,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":184.73,"10th_percentile":184.73,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":225.84,"10th_percentile":225.84,"90th_percentile":225.84,"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":"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":10002.04,"maximum":16196.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10002.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10002.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15803.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10102.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14257.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14257.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10102.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12783.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14257.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14257.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13396.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10402.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12880.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15803.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16196.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10002.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10002.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6223.67,"maximum":10077.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6223.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6223.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6285.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8871.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8871.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6285.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7954.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8871.46},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8871.46},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8335.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6472.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8015.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10077.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6223.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6223.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10281.29,"maximum":16648.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10281.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10281.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16244.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10384.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14655.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14655.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10384.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13140.63},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14655.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14655.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13770.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10692.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13240.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16244.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16648.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10281.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10281.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6158.44,"maximum":9972.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6158.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6158.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9730.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6220.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8778.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8778.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6220.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7871.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8778.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8778.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8248.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6404.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7931.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9730.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9972.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6158.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6158.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14891.97,"maximum":24114.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23529.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15040.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21227.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21227.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15040.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19033.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21227.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21227.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19945.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15487.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19178.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23529.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24114.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14891.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14891.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9507.41,"maximum":15395.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9507.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9507.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15021.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9602.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13552.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13552.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9602.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12151.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13552.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13552.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12733.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9887.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12243.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15021.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15395.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9507.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9507.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc Or Insertion Of","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23694.79,"maximum":38368.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23694.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23694.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37437.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23931.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33775.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33775.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23931.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30284.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33775.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33775.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31735.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24642.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30514.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37437.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38368.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23694.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23694.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12707.57,"maximum":20577.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12707.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12707.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20077.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12834.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18113.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18113.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12834.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16241.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18113.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18113.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17019.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13215.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16365.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20077.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20577.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12707.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12707.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9636.5,"maximum":15604.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9636.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9636.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15225.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9732.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13736.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13736.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9732.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12316.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13736.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13736.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12906.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10021.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12410.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15225.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15604.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9636.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9636.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19618.15,"maximum":31767.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30996.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19814.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27964.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27964.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19814.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25074.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27964.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27964.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26275.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20402.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25264.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30996.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31767.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19618.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10873.08,"maximum":17606.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10981.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15498.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15498.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10981.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13897.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15498.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15498.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14562.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11308.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14002.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17606.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10873.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10873.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10248.67,"maximum":16595.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10248.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10248.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16192.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10351.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14608.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14608.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10351.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13098.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14608.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14608.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13726.44},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10658.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13198.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16192.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10248.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10248.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24182.63,"maximum":39158.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38208.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24424.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34470.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34470.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24424.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30908.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34470.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34470.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32388.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25149.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31143.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38208.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39158.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24182.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12188.48,"maximum":19736.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12188.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12188.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19257.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12310.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17373.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17373.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12310.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15578.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17373.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17373.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16324.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12676.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15696.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19257.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19736.49},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12188.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12188.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8505.91,"maximum":13773.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8505.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8505.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13439.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8590.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12124.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12124.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8590.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10871.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12124.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12124.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11392.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8846.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10954.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13439.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13773.4},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8505.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8505.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20519.77,"maximum":33227.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20519.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20519.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32421.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20724.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29249.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29249.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20724.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26226.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29249.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29249.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27482.91},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21340.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26425.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32421.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33227.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20519.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20519.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10187.52,"maximum":16496.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10187.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10187.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16096.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10289.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14521.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14521.69},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10289.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13020.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14521.69},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14521.69},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13644.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10595.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13119.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16096.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16496.4},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10187.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10187.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6558.64,"maximum":10620.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6558.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6558.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10362.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6624.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9348.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9348.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6624.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8382.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9348.93},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9348.93},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8784.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6820.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8446.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10362.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10620.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6558.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6558.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4754.04,"maximum":7698.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6776.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6776.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4801.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6076.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6776.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6776.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6367.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4944.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6122.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7511.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7698.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4754.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11352.76,"maximum":18383.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11352.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11352.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17937.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11466.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16182.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16182.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11466.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14510.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16182.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16182.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15205.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11806.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14620.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17937.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18383.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11352.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11352.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7435.79,"maximum":12040.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11748.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7510.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10599.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10599.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7510.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9503.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10599.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10599.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9959.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7733.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9576.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11748.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12040.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7435.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5621.01,"maximum":9101.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5621.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5621.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8881.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5677.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8012.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8012.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5677.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7184.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8012.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8012.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7528.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5845.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7238.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8881.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9101.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5621.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5621.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45397.47,"maximum":73510.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":71728.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45851.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":64711.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":64711.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":45851.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":58023.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":64711.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":64711.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60802.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":47213.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58464.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":71728.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":73510.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":45397.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45397.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28813.7,"maximum":46657.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28813.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28813.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45525.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29101.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":41072.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":41072.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":29101.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36827.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41072.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":41072.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38591.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29966.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37107.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45525.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46657.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28813.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28813.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36211.44,"maximum":58636.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36211.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36211.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57214.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36573.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":51617.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":51617.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":36573.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":46282.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":51617.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":51617.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48499.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37659.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46634.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57214.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58636.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":36211.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36211.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21948.63,"maximum":35540.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21948.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21948.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34678.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22168.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31286.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31286.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22168.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28052.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31286.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31286.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29396.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22826.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28266.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34678.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35540.86},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21948.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21948.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Mcc","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57096.07,"maximum":92454.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57096.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57096.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":90211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57667.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":81386.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":81386.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":57667.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":72975.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":81386.93},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":81386.93},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76470.94},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":59379.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":73529.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":90211.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92454.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":57096.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":57096.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Cc","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40515.69,"maximum":65606.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40515.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40515.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":64014.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40920.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":57752.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":57752.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":40920.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":51783.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57752.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":57752.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54264.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":42136.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52177.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64014.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65606.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":40515.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40515.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Without Cc/Mcc","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28350.32,"maximum":45906.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28350.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28350.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44793.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28633.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40411.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40411.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28633.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36234.86},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40411.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40411.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37970.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29484.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36510.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44793.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45906.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28350.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28350.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37525.48,"maximum":60764.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37525.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37525.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":59290.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37900.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":53490.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":53490.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37900.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47961.73},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53490.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":53490.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50259.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39026.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48326.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59290.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60764.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37525.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37525.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18073.11,"maximum":29265.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28555.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18253.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25762.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25762.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18253.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23099.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25762.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25762.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24206.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18796.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23275.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28555.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29265.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18073.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18073.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38724.69,"maximum":62705.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38724.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38724.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":61185.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39111.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":55199.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":55199.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":39111.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":49494.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55199.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":55199.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51865.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40273.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49870.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61185.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62705.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":38724.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38724.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21162.52,"maximum":34267.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21162.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21162.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33436.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30165.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30165.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27048.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30165.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30165.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28343.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22009.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27253.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33436.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34267.93},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21162.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21162.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12390.95,"maximum":20064.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12514.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12514.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15837.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.67},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12886.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15957.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20064.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35367.57,"maximum":57269.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35367.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35367.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":55880.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35721.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":50414.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":50414.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":35721.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":45203.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50414.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":50414.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47369.14},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36782.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45547.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55880.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57269.81},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":35367.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35367.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23961.13,"maximum":38799.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23961.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23961.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24200.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":34155.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":34155.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24200.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":30624.99},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34155.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":34155.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32092.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30857.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37858.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38799.65},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23961.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23961.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18671.01,"maximum":30233.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29500.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26614.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26614.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18857.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23863.63},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26614.38},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26614.38},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25006.8},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19417.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24045.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29500.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30233.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18671.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18671.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20608.78,"maximum":33371.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20608.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20608.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32561.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20814.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29376.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29376.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20814.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26340.31},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29376.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29376.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27602.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21433.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26540.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32561.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33371.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20608.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20608.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13105.72,"maximum":21221.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13105.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13105.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20707.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13236.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18681.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18681.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13236.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16750.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18681.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18681.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17552.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13629.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16877.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20707.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21221.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13105.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13105.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32808.12,"maximum":53125.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32808.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32808.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51836.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33136.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":46765.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":46765.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":33136.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":41932.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46765.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":46765.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43941.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34120.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42251.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51836.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53125.36},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":32808.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32808.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20016.98,"maximum":32412.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31626.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28532.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28532.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20217.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25583.93},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28532.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28532.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26809.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20817.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25778.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31626.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32412.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20016.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20016.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16587.17,"maximum":26859.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16587.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16587.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26207.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16753.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23643.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23643.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16753.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21200.25},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23643.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23643.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22215.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17250.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21361.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26207.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26859.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16587.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16587.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc Or Insertion Of Antib","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29167.68,"maximum":47230.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46084.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":41576.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":41576.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":29459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":37279.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41576.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":41576.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39065.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30334.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37562.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46084.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47230.49},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":29167.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29167.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15462.02,"maximum":25037.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24429.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15616.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22040.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22040.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15616.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19762.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22040.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22040.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20708.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16080.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19912.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24429.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25037.25},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15462.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15462.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8018.75,"maximum":12984.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8018.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8018.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12669.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11430.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11430.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8098.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10248.86},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11430.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11430.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10739.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8339.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10326.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12669.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12984.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8018.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8018.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc Or Insertion Of Antibiotic-Eluting","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23471.94,"maximum":38007.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23471.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23471.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37085.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23706.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33457.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33457.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23706.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29999.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33457.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33457.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31436.86},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24410.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30227.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37085.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38007.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23471.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23471.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16708.79,"maximum":27056.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16708.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16708.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26399.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16875.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23817.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23817.35},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16875.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21355.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23817.35},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23817.35},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22378.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17377.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21518.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26399.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27056.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16708.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16708.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12630.11,"maximum":20451.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19955.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12756.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12756.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16142.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16915.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13135.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16265.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19955.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20451.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc Or Insertion Of Antibiotic-Eluting Bone Void Fi","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19787.33,"maximum":32041.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19787.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19787.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31263.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19985.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28205.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28205.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19985.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25290.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28205.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28205.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26501.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20578.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25482.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31263.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32041.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19787.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19787.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14230.87,"maximum":23043.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14230.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14230.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22484.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14373.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20285.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20285.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14373.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18188.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20285.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20285.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19059.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14800.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18326.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22484.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23043.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14230.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14230.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11081.67,"maximum":17944.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11081.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11081.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17509.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15796.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15796.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14163.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15796.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15796.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14842.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11524.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14271.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17509.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17944.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11081.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11081.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18833.4,"maximum":30496.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29756.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19021.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26845.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26845.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19021.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24071.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26845.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26845.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25224.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19586.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24254.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29756.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30496.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18833.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18833.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21926.21,"maximum":35504.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21926.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21926.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34643.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22145.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31254.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31254.46},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22145.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28024.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31254.46},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31254.46},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29366.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22803.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28237.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34643.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35504.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21926.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21926.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14207.77,"maximum":23006.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14207.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14207.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22448.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14349.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20252.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20252.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14349.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18159.11},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20252.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20252.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19029.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14776.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18297.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22448.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23006.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14207.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14207.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10641.39,"maximum":17231.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10747.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15168.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15168.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10747.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13600.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15168.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15168.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14252.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11067.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13704.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17231.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10641.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12018.62,"maximum":19461.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12018.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12018.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18989.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12138.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17131.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17131.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12138.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15361.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17131.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17131.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16096.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12499.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15477.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18989.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19461.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12018.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12018.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7587.99,"maximum":12287.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11989.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9698.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10162.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7891.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9772.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11989.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12287.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc Or Insertion Of Antibioti","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24946.32,"maximum":40394.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24946.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24946.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39415.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25195.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35559.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35559.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25195.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31884.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35559.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35559.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33411.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25944.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32126.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39415.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40394.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24946.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24946.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17231.28,"maximum":27902.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17231.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17231.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27225.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17403.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24562.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24562.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17403.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22023.49},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24562.13},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24562.13},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23078.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17920.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22190.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27225.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27902.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17231.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17231.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13632.97,"maximum":22075.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13632.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13632.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21540.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13769.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19432.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19432.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13769.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17424.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19432.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19432.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18259.15},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14178.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17556.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21540.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22075.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13632.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13632.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24634.46,"maximum":39889.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38922.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24880.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35114.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35114.9},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24880.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31485.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35114.9},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35114.9},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32993.87},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25619.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31724.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38922.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39889.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24634.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24634.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12256.42,"maximum":19846.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12256.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12256.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19365.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12378.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17470.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17470.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12378.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15665.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17470.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17470.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16415.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12746.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15784.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19365.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19846.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12256.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12256.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8209.67,"maximum":13293.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8209.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8209.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12971.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8291.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11702.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11702.39},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8291.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10492.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11702.39},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11702.39},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10995.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8538.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10572.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12971.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13293.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8209.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8209.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20497.35,"maximum":33190.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20497.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20497.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32385.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20702.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29217.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29217.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20702.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26197.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29217.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29217.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27452.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21317.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26397.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32385.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33190.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20497.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20497.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13689.36,"maximum":22166.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21629.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13826.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19513.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19513.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13826.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17496.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19513.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19513.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18334.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14236.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17629.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21629.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22166.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13689.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13689.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21502.92,"maximum":34819.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33974.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30651.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30651.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27483.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30651.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30651.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28799.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22363.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27692.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33974.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34819.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21502.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9025.0,"maximum":14613.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9025.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9025.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9115.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12864.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12864.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9115.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11534.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12864.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12864.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12087.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9386.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11622.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14613.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9025.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9025.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc Or Insertion Of Antibiotic-Eluti","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25321.37,"maximum":41002.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25321.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25321.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40007.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25574.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":36094.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":36094.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25574.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32363.53},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36094.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":36094.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33913.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26334.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32609.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40007.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41002.25},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25321.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25321.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14803.64,"maximum":23971.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23389.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14951.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21101.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21101.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14951.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18920.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21101.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21101.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19827.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19064.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23389.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23971.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14803.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14803.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9916.43,"maximum":16057.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9916.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9916.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15667.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10015.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14135.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14135.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10015.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12674.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14135.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14135.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13281.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10313.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12770.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15667.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16057.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9916.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9916.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9761.52,"maximum":15806.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15423.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9859.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13914.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13914.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9859.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12476.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13914.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13914.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13073.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10151.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12571.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15423.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15806.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9761.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9761.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6089.14,"maximum":9859.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6089.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6089.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9620.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6150.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8679.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8679.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6150.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7782.6},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8679.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8679.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8155.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6332.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7841.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9620.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9859.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6089.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6089.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5932.93,"10th_percentile":5932.93,"90th_percentile":5932.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"1 through 10","median_amount":156.96,"10th_percentile":156.96,"90th_percentile":156.96,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4220.68,"maximum":6834.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4220.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4220.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6668.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4262.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6016.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6016.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4262.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5394.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6016.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6016.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5652.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4389.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5435.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6668.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6834.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4220.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4220.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":43.17,"10th_percentile":43.17,"90th_percentile":43.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":172.69,"10th_percentile":172.69,"90th_percentile":172.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9074.6,"maximum":14694.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9074.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9074.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14337.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9165.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12935.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12935.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9165.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11598.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12935.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12935.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12153.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9437.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11686.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14337.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14694.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9074.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9074.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5287.4,"maximum":8561.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5287.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5287.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8354.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5340.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7536.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7536.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5340.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6757.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7536.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7536.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7081.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5498.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6809.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8354.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8561.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5287.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5287.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":184.73,"10th_percentile":184.73,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9662.32,"maximum":15645.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9662.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9662.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15266.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9758.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13773.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13773.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9758.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12349.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13773.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13773.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12941.11},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10048.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12443.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15266.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15645.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9662.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9662.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11184.26,"maximum":18110.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17671.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11296.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15942.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15942.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11296.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14294.73},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15942.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15942.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14979.51},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11631.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14403.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17671.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18110.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11184.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6964.26,"maximum":11277.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6964.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6964.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11003.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9927.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9927.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7033.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8901.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9927.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9927.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9327.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7242.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8968.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11003.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11277.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6964.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6964.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5220.14,"maximum":8452.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8247.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5272.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7440.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7440.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5272.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6671.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7440.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7440.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6991.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5428.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6722.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8247.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8452.84},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5220.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5220.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31943.2,"maximum":51724.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31943.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31943.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50470.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32262.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":45533.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":45533.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":32262.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":40826.96},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45533.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":45533.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42782.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33220.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41137.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50470.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51724.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31943.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31943.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25178.69,"maximum":40771.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25178.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25178.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25430.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35890.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35890.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25430.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32181.17},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35890.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35890.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33722.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26185.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32425.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39782.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40771.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25178.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25178.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21942.52,"maximum":35530.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21942.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21942.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34669.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22161.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31277.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31277.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22161.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28044.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31277.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31277.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29388.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22820.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28258.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34669.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35530.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21942.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21942.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35306.42,"maximum":57170.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35306.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35306.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":55784.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35659.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":50327.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":50327.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":35659.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":45125.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":50327.13},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":50327.13},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47287.24},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":36718.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45468.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55784.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57170.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":35306.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":35306.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19019.57,"maximum":30797.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19019.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19019.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19209.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27111.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27111.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19209.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24309.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27111.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27111.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25473.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19780.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24493.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30050.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30797.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19019.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19019.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14381.03,"maximum":23286.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22722.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14524.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20499.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20499.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14524.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18380.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20499.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20499.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19261.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14956.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18520.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22722.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23286.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14381.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14381.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21632.01,"maximum":35028.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21632.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21632.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34178.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21848.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30835.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30835.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21848.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27648.12},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30835.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30835.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28972.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22497.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27858.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34178.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35028.17},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21632.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21632.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12433.75,"maximum":20133.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12433.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12433.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19645.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12558.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17723.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17723.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12558.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15891.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17723.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17723.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16653.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12931.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16012.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19645.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20133.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12433.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12433.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10543.55,"maximum":17072.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10543.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10543.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16658.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10648.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15029.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15029.18},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10648.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13475.83},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15029.18},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15029.18},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14121.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10965.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13578.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16658.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17072.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10543.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10543.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17263.89,"maximum":27954.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27276.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17436.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24608.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24608.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17436.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22065.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24608.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24608.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23122.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17954.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22232.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27276.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27954.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17263.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17263.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8980.16,"maximum":14541.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14188.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9069.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12800.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12800.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9069.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11477.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12800.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12800.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12027.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9339.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11564.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14188.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14541.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8980.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8980.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7034.92,"maximum":11391.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7034.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7034.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11115.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7105.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10027.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10027.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7105.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8991.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10027.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10027.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9422.14},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7316.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9059.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11115.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11391.47},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7034.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7034.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20801.06,"maximum":33682.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20801.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20801.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32865.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":29650.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":29650.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21009.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":26586.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29650.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":29650.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27859.65},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21633.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26788.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32865.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33682.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20801.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20801.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10328.85,"maximum":16725.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10328.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10328.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16319.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14723.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14723.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13201.42},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14723.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14723.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13833.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10742.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13301.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16319.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16725.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10328.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10328.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7113.06,"maximum":11517.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11238.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7184.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10139.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10139.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7184.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9091.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10139.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10139.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9526.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7397.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9160.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11238.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11517.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7113.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7113.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21206.68,"maximum":34339.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21206.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21206.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33506.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21418.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30228.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30228.82},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21418.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27104.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30228.82},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30228.82},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28402.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22054.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27310.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33506.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34339.44},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21206.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21206.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11885.45,"maximum":19245.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11885.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11885.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18779.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12004.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16941.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16941.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12004.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15190.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16941.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16941.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15918.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12360.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15306.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18779.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19245.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11885.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11885.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7515.97,"maximum":12170.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7515.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7515.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11875.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7591.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10713.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10713.55},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7591.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9606.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10713.55},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10713.55},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10066.42},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7816.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9679.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11875.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12170.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7515.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7515.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19839.65,"maximum":32125.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19839.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19839.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31346.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20038.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28280.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28280.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20038.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25357.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28280.2},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28280.2},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26572.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25550.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31346.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32125.84},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19839.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19839.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10544.91,"maximum":17075.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10544.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10544.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16660.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10650.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15031.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15031.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10650.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13477.57},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15031.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15031.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14123.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10966.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13580.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16660.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17075.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10544.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10544.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6640.17,"maximum":10752.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6640.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6640.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10491.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6706.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9465.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9465.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6706.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8486.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9465.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9465.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8893.43},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6905.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8551.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10491.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10752.25},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6640.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6640.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12195.95,"maximum":19748.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12195.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12195.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19269.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12317.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17384.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17384.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12317.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15587.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17384.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17384.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16334.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12683.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15706.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19269.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19748.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12195.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12195.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7334.56,"maximum":11876.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7334.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7334.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11588.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7407.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10454.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10454.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7407.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9374.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10454.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10454.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9823.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7627.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9445.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11588.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11876.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7334.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7334.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28547.35,"maximum":46226.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28547.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28547.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45104.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28832.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40692.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40692.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28832.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36486.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40692.5},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40692.5},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38234.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29689.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36764.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45104.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46226.0},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28547.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28547.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15889.39,"maximum":25729.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25105.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16048.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22649.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22649.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16048.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20308.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22649.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22649.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21281.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16524.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20462.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25105.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25729.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15889.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11152.33,"maximum":18058.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11152.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11152.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17620.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11263.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15896.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15896.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11263.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14253.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15896.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15896.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14936.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11598.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14362.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17620.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18058.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11152.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11152.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10062.51,"maximum":16293.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10062.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10062.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15898.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10163.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14343.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14343.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10163.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12861.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14343.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14343.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13477.1},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10465.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12958.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15898.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16293.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10062.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10062.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5950.54,"maximum":9635.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5950.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5950.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9401.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6010.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8482.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8482.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6010.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7605.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8482.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8482.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7969.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6188.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7663.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9401.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9635.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5950.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5950.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4078.68,"maximum":6604.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4119.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5813.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5813.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4119.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5213.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5813.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5813.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5462.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4241.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5252.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6444.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6604.5},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4078.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12255.06,"maximum":19844.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12255.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12255.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19362.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17468.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17468.83},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12377.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15663.33},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17468.83},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17468.83},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16413.67},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15782.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19362.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19844.31},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12255.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12255.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7119.17,"maximum":11527.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7119.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7119.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11248.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7190.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10147.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10147.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7190.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9099.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10147.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10147.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9534.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7403.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9168.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11248.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11527.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7119.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7119.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5369.61,"maximum":8694.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5369.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5369.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8483.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5423.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7654.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7654.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5423.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6862.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7654.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7654.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7191.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5584.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6915.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8483.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8694.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5369.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5369.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7883.54,"maximum":12765.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7883.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7883.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12455.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7962.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11237.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11237.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7962.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10076.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11237.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11237.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10558.73},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8198.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10152.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12455.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12765.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7883.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7883.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5500.07,"maximum":8906.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5500.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5500.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8690.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5555.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7840.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7840.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5555.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7029.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7840.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7840.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7366.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5720.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7083.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8690.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8906.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5500.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5500.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9135.07,"maximum":14792.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9135.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9135.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14433.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9226.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13021.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13021.48},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9226.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11675.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13021.48},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13021.48},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12234.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9500.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11764.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14433.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14792.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9135.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9135.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5311.18,"maximum":8600.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5311.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5311.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8391.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5364.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7570.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7570.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5364.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6788.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7570.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7570.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7113.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5523.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6839.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8391.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8600.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5311.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5311.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7771.44,"maximum":12584.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7771.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7771.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12278.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7849.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11077.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11077.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7849.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9932.76},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11077.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11077.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10408.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8082.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10008.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12278.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12584.09},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7771.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7771.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4681.34,"maximum":7580.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7396.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4728.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6672.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6672.96},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4728.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5983.28},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6672.96},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6672.96},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6269.9},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4868.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6028.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7396.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7580.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4681.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4681.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7323.01,"maximum":11857.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7323.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7323.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11570.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7396.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10438.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10438.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7396.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9359.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10438.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10438.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9807.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7615.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9430.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11570.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11857.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7323.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7323.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11240.66,"maximum":18201.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17760.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11353.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16022.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16022.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11353.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14366.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16022.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16022.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15055.04},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11690.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14476.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17760.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18201.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11240.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6896.32,"maximum":11167.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6896.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6896.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10896.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6965.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9830.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9830.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6965.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8814.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9830.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9830.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9236.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7172.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8881.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10896.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11167.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6896.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6896.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4687.46,"maximum":7590.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4687.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4687.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7406.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4734.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6681.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6681.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4734.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5991.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6681.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6681.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6278.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4874.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6036.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7406.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7590.28},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4687.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4687.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21979.21,"maximum":35590.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21979.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21979.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34727.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22199.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31330.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31330.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22199.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":28091.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31330.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31330.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29437.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22858.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28305.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34727.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35590.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21979.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21979.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11084.39,"maximum":17948.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17513.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11195.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15800.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15800.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11195.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14167.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15800.11},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15800.11},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14845.74},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11527.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14274.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17513.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17948.66},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11084.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6865.06,"maximum":11116.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6865.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6865.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10846.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6933.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9785.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9785.72},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6933.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8774.31},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9785.72},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9785.72},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9194.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7139.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8841.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10846.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11116.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6865.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6865.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13553.47,"maximum":21946.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13553.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13553.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13689.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19319.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19319.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13689.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17322.84},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19319.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19319.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18152.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14095.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17454.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21414.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21946.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13553.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13553.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8271.5,"maximum":13393.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8271.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8271.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13068.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8354.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11790.52},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11790.52},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8354.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10571.9},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11790.52},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11790.52},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11078.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8602.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10652.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13068.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13393.83},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8271.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8271.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5786.11,"maximum":9369.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5786.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5786.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9142.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5843.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8247.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8247.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5843.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7395.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8247.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8247.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7749.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6017.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7451.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9142.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9369.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5786.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5786.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17614.48,"maximum":28522.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17614.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17614.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27830.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17790.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25108.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25108.36},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17790.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22513.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25108.36},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25108.36},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23591.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18319.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22684.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27830.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28522.68},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17614.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17614.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8888.44,"maximum":14392.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14043.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8977.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12669.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12669.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8977.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11360.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12669.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12669.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11904.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9243.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11446.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14043.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14392.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8888.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5771.16,"maximum":9345.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9118.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5828.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8226.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8226.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5828.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7376.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8226.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8226.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7729.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6002.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7432.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9118.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9345.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5771.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18409.43,"maximum":29809.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29086.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26241.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26241.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23529.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26241.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26241.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24656.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19145.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23708.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29086.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29809.92},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18409.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18409.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58836.11,"maximum":95271.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":58836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":58836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":92961.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":59424.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":83867.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":83867.26},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":59424.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":75199.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":83867.26},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":83867.26},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78801.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":61189.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":75770.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92961.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":95271.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":58836.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":58836.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33554.83,"maximum":54334.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33554.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33554.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53016.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33890.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":47830.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":47830.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":33890.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":42886.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47830.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":47830.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44941.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":34897.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43212.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53016.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54334.48},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":33554.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33554.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13575.89,"maximum":21983.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13575.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13575.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21449.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13711.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19351.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19351.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13711.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17351.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19351.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19351.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18182.71},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14118.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17483.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21449.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21983.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13575.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13575.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10172.58,"maximum":16472.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16072.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10274.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14500.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14500.38},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10274.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13001.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14500.38},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14500.38},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13624.52},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10579.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13100.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16072.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16472.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10172.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10172.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30905.69,"maximum":50044.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30905.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30905.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48830.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31214.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44054.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44054.16},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31214.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39500.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44054.16},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44054.16},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41393.17},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32141.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39801.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48830.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50044.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30905.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30905.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14550.21,"maximum":23560.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14550.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14550.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22989.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14695.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20740.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20740.43},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14695.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18596.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20740.43},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20740.43},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19487.65},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15132.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18738.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22989.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23560.78},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14550.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14550.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9463.92,"maximum":15324.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9463.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9463.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14952.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9558.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13490.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13490.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9558.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12095.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13490.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13490.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12675.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9842.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12187.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14952.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15324.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9463.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9463.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12390.95,"maximum":20064.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12514.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12514.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15837.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17662.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.67},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12886.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15957.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19577.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20064.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12390.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6780.13,"maximum":10978.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6780.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6780.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10712.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6847.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9664.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9664.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6847.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8665.76},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9664.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9664.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9080.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7051.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8731.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10712.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10978.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6780.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6780.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6031.39,"maximum":9766.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6031.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6031.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9529.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6091.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8597.37},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8597.37},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6091.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7708.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8597.37},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8597.37},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8078.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6272.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7767.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9529.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9766.48},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6031.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6031.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10180.05,"maximum":16484.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10180.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10180.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16084.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10281.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14511.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14511.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10281.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13011.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14511.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14511.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13634.53},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10587.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13110.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16084.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16484.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10180.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10180.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5908.41,"maximum":9567.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5908.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5908.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9335.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5967.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8422.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8422.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5967.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7551.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8422.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8422.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7913.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6144.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7609.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9335.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9567.34},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5908.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5908.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14222.04,"maximum":23029.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22470.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14364.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20272.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20272.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14364.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18177.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20272.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20272.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19048.12},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14790.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18315.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22470.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23029.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14222.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14222.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7005.71,"maximum":11344.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7005.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7005.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11069.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7075.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9986.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9986.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7075.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8954.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9986.2},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9986.2},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9383.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7285.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9022.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11069.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11344.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7005.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7005.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4957.87,"maximum":8028.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4957.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4957.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7833.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5007.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7067.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7067.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5007.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6336.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7067.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7067.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6640.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5156.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6384.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7833.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8028.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4957.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4957.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46961.54,"maximum":76043.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46961.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46961.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":74199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47431.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":66940.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":66940.78},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":47431.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":60022.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":66940.78},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":66940.78},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62897.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48840.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60478.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":74199.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76043.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":46961.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":46961.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13198.12,"maximum":21371.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20853.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13330.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18813.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18813.11},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13330.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16868.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18813.11},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18813.11},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17676.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13726.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16996.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20853.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21371.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13198.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13198.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6952.71,"maximum":11258.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6952.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6952.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10985.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7022.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9910.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9910.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7022.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8886.34},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9910.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9910.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9312.03},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7230.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8953.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10985.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11258.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6952.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6952.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26259.68,"maximum":42521.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26259.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26259.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26522.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37431.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37431.56},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26522.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33562.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37431.56},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37431.56},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35170.59},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27310.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33817.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41490.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42521.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26259.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26259.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6523.98,"maximum":10564.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6523.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6523.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10307.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6589.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9299.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9299.54},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6589.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8338.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9299.54},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9299.54},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8737.82},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6784.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8401.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10307.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10564.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6523.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6523.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":184.73,"10th_percentile":184.73,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":215.86,"10th_percentile":215.86,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":151.1,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":71.5,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":71.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6392.85,"maximum":10351.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6392.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6392.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10100.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6456.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6456.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8170.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9112.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8562.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6648.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8232.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10100.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10351.78},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6392.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6392.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":160.06,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"12","median_amount":184.73,"10th_percentile":184.73,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":172.69,"10th_percentile":172.69,"90th_percentile":172.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":194.27,"10th_percentile":134.04,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":134.04,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7295.83,"maximum":11813.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11527.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7368.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10399.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10399.75},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7368.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9324.88},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10399.75},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10399.75},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9771.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9395.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11527.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11813.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":74.76,"10th_percentile":74.76,"90th_percentile":74.76,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":119.15,"10th_percentile":119.15,"90th_percentile":119.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"1 through 10","median_amount":137.18,"10th_percentile":137.18,"90th_percentile":137.18,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13359.83,"maximum":21633.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13359.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13359.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21108.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13493.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19043.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19043.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13493.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17075.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19043.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19043.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17893.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13894.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17205.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21108.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21633.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13359.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13359.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10931.51,"maximum":17701.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10931.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10931.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17271.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11040.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15582.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15582.2},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11040.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13971.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15582.2},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15582.2},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14640.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11368.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14077.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17271.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17701.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10931.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10931.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9490.42,"maximum":15367.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9490.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9490.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14994.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9585.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13528.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13528.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9585.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12129.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13528.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13528.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12710.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9870.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12222.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14994.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15367.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9490.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9490.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":159.47,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":163.82,"10th_percentile":160.06,"90th_percentile":164.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"46","median_amount":138.55,"10th_percentile":74.76,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"1 through 10","median_amount":83.75,"10th_percentile":75.38,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":215.86,"10th_percentile":215.86,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"17","median_amount":194.27,"10th_percentile":134.04,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"33","median_amount":194.27,"10th_percentile":134.04,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":195.5,"10th_percentile":195.5,"90th_percentile":234.89,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"1 through 10","median_amount":90.45,"10th_percentile":90.45,"90th_percentile":90.45,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":83.75,"10th_percentile":71.5,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"1 through 10","median_amount":159.47,"10th_percentile":159.47,"90th_percentile":159.47,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":168.52,"10th_percentile":168.52,"90th_percentile":168.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14100.42,"maximum":22832.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14100.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14100.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22278.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14241.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20099.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20099.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14241.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18021.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20099.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20099.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18885.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14664.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18158.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22278.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22832.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14100.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14100.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":71.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7276.12,"maximum":11782.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11496.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7348.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10371.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10371.67},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7348.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9299.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10371.67},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10371.67},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9745.19},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7567.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9370.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11496.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11782.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7276.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4191.47,"maximum":6787.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4191.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4191.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6622.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4233.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5974.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5974.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4233.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5357.16},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5974.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5974.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5613.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4359.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5397.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6622.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6787.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4191.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4191.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":189.57,"10th_percentile":189.57,"90th_percentile":189.57,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":215.86,"10th_percentile":215.86,"90th_percentile":215.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9618.15,"maximum":15574.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15196.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9714.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13710.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13710.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9714.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12293.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13710.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13710.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12881.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10002.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12386.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15196.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15574.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9618.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9618.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11856.91,"maximum":19199.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11856.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11856.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18733.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11975.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16901.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16901.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11975.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15154.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16901.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16901.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15880.41},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12331.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15269.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18733.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19199.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11856.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11856.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5998.1,"maximum":9712.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5998.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5998.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9477.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8549.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8549.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6058.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7666.24},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8549.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8549.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8033.48},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6238.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7724.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9477.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9712.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5998.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5998.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":74.76,"10th_percentile":74.76,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"1 through 10","median_amount":194.27,"10th_percentile":148.93,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":125.86,"10th_percentile":125.86,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":83.75,"10th_percentile":83.75,"90th_percentile":83.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28513.38,"maximum":46170.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28513.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28513.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45051.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28798.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40644.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40644.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28798.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36443.27},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40644.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40644.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38189.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29653.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36720.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45051.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46170.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28513.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28513.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13007.88,"maximum":21063.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13007.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13007.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20552.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18541.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18541.93},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16625.52},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18541.93},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18541.93},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17421.95},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13528.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16751.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20552.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21063.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13007.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13007.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7946.73,"maximum":12867.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7946.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7946.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12555.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11327.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11327.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8026.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10156.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11327.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11327.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10643.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8264.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10234.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12555.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12867.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7946.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7946.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24956.51,"maximum":40411.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39431.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25206.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35573.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35573.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25206.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31897.2},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35573.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35573.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33425.21},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25954.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32139.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39431.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40411.45},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24956.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10078.81,"maximum":16320.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10078.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10078.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15924.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14366.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14366.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12881.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14366.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14366.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13498.94},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10481.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12979.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15924.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16320.37},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10078.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10078.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13346.24,"maximum":21611.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13346.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13346.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21087.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19024.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19024.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13479.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17057.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19024.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19024.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17875.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13880.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17187.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21087.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21611.23},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13346.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13346.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26085.74,"maximum":42239.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26085.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26085.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41215.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26346.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37183.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37183.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26346.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33340.48},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37183.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37183.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34937.63},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27129.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33593.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41215.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42239.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26085.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26085.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13556.19,"maximum":21951.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13556.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13556.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13691.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19323.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19323.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13691.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17326.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19323.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19323.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18156.32},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14098.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17458.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21951.19},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13556.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13556.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8919.01,"maximum":14442.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8919.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8919.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14092.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9008.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12713.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12713.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9008.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11399.49},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12713.5},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12713.5},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11945.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9275.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11486.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14092.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14442.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8919.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8919.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11106.13,"maximum":17983.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11106.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11106.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17547.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15831.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15831.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11217.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14194.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15831.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15831.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14874.86},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11550.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14302.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17547.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17983.87},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11106.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11106.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6016.44,"maximum":9742.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9505.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6076.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8576.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8576.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6076.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7689.68},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8576.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8576.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8058.05},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6257.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7748.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9505.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9742.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6016.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6016.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":172.69,"10th_percentile":172.69,"90th_percentile":172.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11425.46,"maximum":18500.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11425.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11425.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18052.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16286.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16286.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14603.01},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16286.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16286.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15302.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11882.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14714.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18052.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18500.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11425.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11425.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4527.11,"maximum":7330.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4527.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4527.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7152.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4572.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6453.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6453.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4572.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5786.15},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6453.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6453.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6063.33},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4708.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5830.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7152.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7330.63},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4527.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4527.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10656.34,"maximum":17255.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10656.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10656.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10762.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15189.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15189.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10762.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13619.99},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15189.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15189.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14272.44},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11082.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13723.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16837.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17255.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10656.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10656.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5823.48,"maximum":9429.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5823.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5823.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9201.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5881.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8301.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8301.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5881.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7443.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8301.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8301.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7799.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6056.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7499.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9201.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9429.81},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5823.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5823.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"1 through 10","median_amount":184.73,"10th_percentile":184.73,"90th_percentile":184.73,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"90th_percentile":194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"90th_percentile":194.27,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12439.19,"maximum":20142.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19653.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12563.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17731.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17731.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12563.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15898.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17731.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17731.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16660.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12936.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16019.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19653.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20142.46},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12439.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6810.03,"maximum":11027.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6810.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6810.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10759.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6878.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9707.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9707.28},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6878.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8703.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9707.28},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9707.28},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9120.93},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7082.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8770.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10759.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11027.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6810.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6810.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4677.27,"maximum":7573.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4677.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4677.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7390.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4724.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6667.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6667.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4724.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5978.07},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6667.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6667.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6264.44},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4864.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6023.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7390.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7573.78},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4677.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4677.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11886.12,"maximum":19246.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18780.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12004.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16942.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16942.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12004.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15191.79},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16942.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16942.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15919.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12361.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15307.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18780.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19246.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11886.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6914.66,"maximum":11196.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6914.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6914.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10925.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6983.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9856.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9856.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6983.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8837.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9856.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9856.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9261.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7191.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8904.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10925.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11196.74},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6914.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6914.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":145063.86,"maximum":234898.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":145063.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":145063.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":229200.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":146514.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":206779.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":206779.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":146514.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":185407.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":206779.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":206779.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":194289.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":150866.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":186816.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":229200.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":234898.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":145063.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":145063.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48734.2,"maximum":78914.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48734.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48734.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":77000.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":69467.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":69467.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":49221.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":62287.73},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":69467.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":69467.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65271.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":50683.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62761.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":77000.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78914.05},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":48734.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":48734.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21883.41,"maximum":35435.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21883.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21883.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22102.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":31193.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":31193.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":22102.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27969.43},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31193.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":31193.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29309.28},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22758.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28182.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35435.24},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21883.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21883.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26458.76,"maximum":42843.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26458.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26458.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26723.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":37715.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":37715.33},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":26723.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":33817.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":37715.33},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":37715.33},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35437.22},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27517.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34074.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42843.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":26458.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26458.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15019.7,"maximum":24321.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15019.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15019.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23731.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15169.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21409.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21409.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15169.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19196.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21409.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21409.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20116.46},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15620.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19342.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23731.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24321.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15019.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15019.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13996.47,"maximum":22664.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13996.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13996.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22114.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19951.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19951.1},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14136.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17889.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19951.1},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19951.1},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18746.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14556.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18025.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22114.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22664.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13996.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13996.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24653.48,"maximum":39920.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24653.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24653.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38952.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":35142.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":35142.02},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":24900.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":31509.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35142.02},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":35142.02},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33019.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25639.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31749.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38952.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39920.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":24653.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24653.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15877.84,"maximum":25710.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25086.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16036.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22632.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22632.88},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16036.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20293.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22632.88},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22632.88},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21265.79},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20447.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25086.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25710.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15877.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15877.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13777.01,"maximum":22308.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13777.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13777.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13914.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":19638.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":19638.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13914.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":17608.55},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19638.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":19638.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18452.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14328.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17742.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21767.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22308.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":13777.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13777.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10521.81,"maximum":17037.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16624.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10627.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14998.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14998.19},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10627.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13448.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14998.19},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14998.19},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14092.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10942.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13550.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16624.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17037.7},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10521.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7791.82,"maximum":12617.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7791.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7791.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12311.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7869.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11106.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11106.76},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7869.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9958.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11106.76},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11106.76},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10435.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8103.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10034.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12311.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12617.09},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7791.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7791.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8624.81,"maximum":13965.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8624.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8624.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13627.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8711.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12294.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12294.14},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8711.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11023.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12294.14},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12294.14},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11551.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8969.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11107.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13627.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13965.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8624.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8624.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5438.92,"maximum":8807.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5438.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5438.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7752.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7752.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5493.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6951.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7752.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7752.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7284.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5656.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7004.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8593.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8807.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5438.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5438.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8083.3,"maximum":13089.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12771.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8164.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11522.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11522.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8164.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10331.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11522.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11522.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10826.27},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10409.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12771.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13089.08},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8083.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4264.85,"maximum":6905.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4264.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4264.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6738.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6079.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6079.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5450.95},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6079.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6079.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5712.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4435.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5492.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6738.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6905.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4264.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4264.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3777.69,"maximum":6117.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3777.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3777.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5968.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3815.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5384.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5384.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3815.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4828.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5384.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5384.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5059.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3928.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4865.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5968.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6117.11},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3777.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3777.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17445.3,"maximum":28248.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17445.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17445.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27563.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17619.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":24867.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":24867.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":17619.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22297.04},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":24867.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":24867.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23365.16},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18143.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22466.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27563.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28248.74},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17445.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17445.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10027.18,"maximum":16236.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15842.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10127.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14293.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14293.12},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10127.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12815.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14293.12},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14293.12},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13429.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10428.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12913.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15842.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16236.75},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10027.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12513.25,"maximum":20262.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12513.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12513.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19770.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12638.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17836.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17836.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12638.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15993.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17836.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17836.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16759.47},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16114.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19770.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20262.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12513.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12513.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7390.95,"maximum":11967.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11677.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10535.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10535.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7464.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9446.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10535.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10535.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9898.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7686.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9518.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11677.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11967.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7390.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7390.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6526.02,"maximum":10567.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6526.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6526.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10311.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6591.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9302.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9302.44},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6591.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8340.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9302.44},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9302.44},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8740.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6787.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8404.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10311.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10567.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6526.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6526.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9728.9,"maximum":15753.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15371.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9826.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13867.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13867.95},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9826.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12434.62},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13867.95},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13867.95},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13030.29},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10118.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12529.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15371.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15753.76},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9728.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6651.72,"maximum":10770.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6651.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6651.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6718.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9481.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9481.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6718.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8501.64},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9481.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9481.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8908.9},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6917.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8566.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10509.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10770.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6651.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6651.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4508.76,"maximum":7300.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7123.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4553.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6426.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6426.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4553.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5762.7},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6426.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6426.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6038.76},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4689.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5806.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7123.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7300.93},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4508.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4508.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6845.36,"maximum":11084.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6845.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6845.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10815.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6913.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9757.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9757.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6913.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8749.13},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9757.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9757.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9168.25},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7119.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8815.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10815.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11084.52},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6845.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6845.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3876.21,"maximum":6276.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3876.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3876.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6124.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3914.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5525.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5525.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3914.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4954.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5525.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5525.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5191.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4031.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4991.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6124.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6276.64},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3876.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3876.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7280.88,"maximum":11789.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11503.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7353.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10378.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10378.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7353.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9305.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10378.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10378.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9751.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7572.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9376.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11503.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11789.74},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7280.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11481.18,"maximum":18591.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11481.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11481.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18140.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11595.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16365.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16365.71},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11595.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14674.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16365.71},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16365.71},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15377.18},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11940.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14785.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18140.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18591.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11481.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11481.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6812.75,"maximum":11031.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6812.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6812.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10764.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6880.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6880.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8707.45},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9711.15},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9124.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7085.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8773.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10764.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11031.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6812.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6812.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4448.29,"maximum":7203.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4448.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4448.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7028.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4492.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6340.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6340.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4492.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5685.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6340.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6340.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5957.77},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4626.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5728.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7028.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7203.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4448.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4448.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5716.13,"maximum":9255.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5716.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5716.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9031.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5773.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8147.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8147.99},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5773.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7305.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8147.99},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8147.99},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7655.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5944.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7361.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9031.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9255.98},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5716.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5716.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16680.93,"maximum":27011.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26355.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16847.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23777.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23777.64},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16847.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21320.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23777.64},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23777.64},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22341.41},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17348.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21482.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26355.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27011.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16680.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7202.74,"maximum":11663.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7202.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7202.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7274.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10267.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10267.07},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7274.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9205.91},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10267.07},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10267.07},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9646.91},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7490.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9275.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11663.22},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7202.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7202.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6507.68,"maximum":10537.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10282.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6572.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9276.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9276.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6572.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8317.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9276.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9276.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8715.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6767.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8380.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10282.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10537.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6507.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45733.79,"maximum":74055.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":72259.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46191.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":65190.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":65190.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":46191.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":58452.87},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":65190.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":65190.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61253.01},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":47563.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58897.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72259.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":74055.56},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":45733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":45733.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25567.33,"maximum":41400.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25567.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25567.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40396.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25823.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":36444.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":36444.66},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":25823.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":32677.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36444.66},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":36444.66},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34243.3},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":26590.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32926.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40396.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41400.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":25567.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":25567.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51772.65,"maximum":83834.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51772.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51772.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":81800.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52290.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":73798.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":73798.73},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":52290.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":66171.21},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":73798.73},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":73798.73},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69341.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":53843.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":66674.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":81800.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83834.14},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":51772.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":51772.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28630.93,"maximum":46361.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28630.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28630.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45236.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28917.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40811.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40811.62},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28917.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36593.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40811.62},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40811.62},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38346.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29776.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36871.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45236.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46361.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28630.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28630.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20003.4,"maximum":32390.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20003.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20003.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31605.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20203.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":28513.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":28513.61},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":20203.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25566.56},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28513.61},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":28513.61},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26791.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20803.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25760.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31605.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32390.99},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":20003.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20003.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18574.53,"maximum":30077.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18574.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18574.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29347.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18760.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":26476.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":26476.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18760.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":23740.32},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26476.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":26476.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24877.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19317.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23920.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29347.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30077.27},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":18574.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18574.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10413.1,"maximum":16861.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10413.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10413.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16452.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10517.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14843.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14843.23},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10517.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13309.1},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14843.23},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14843.23},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13946.66},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10829.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13410.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16452.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16861.67},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10413.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10413.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6390.13,"maximum":10347.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6390.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6390.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10096.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6454.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9108.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9108.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6454.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8167.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9108.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9108.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8558.55},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6645.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8229.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10096.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10347.38},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6390.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6390.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41590.57,"maximum":67346.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41590.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41590.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":65713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42006.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":59284.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":59284.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":42006.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":53157.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59284.79},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":59284.79},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55703.83},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":43254.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53561.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65713.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67346.54},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":41590.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41590.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17919.55,"maximum":29016.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28312.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18098.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":25543.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":25543.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":18098.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":22903.18},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25543.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":25543.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24000.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":18636.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23077.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28312.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29016.67},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":17919.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17919.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19608.64,"maximum":31751.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19608.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19608.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30981.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19804.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27950.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27950.91},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19804.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":25062.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27950.91},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27950.91},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26262.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":20392.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25252.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30981.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31751.77},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19608.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19608.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8798.75,"maximum":14247.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8798.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8798.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13902.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8886.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12542.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12542.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8886.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11245.78},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12542.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12542.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11784.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9150.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11331.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13902.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14247.59},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8798.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8798.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6133.31,"maximum":9931.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6133.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6133.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9690.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6194.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8742.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8742.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6194.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7839.05},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8742.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8742.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8214.57},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6378.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7898.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9690.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9931.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6133.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6133.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8817.09,"maximum":14277.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8817.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8817.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13931.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8905.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12568.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12568.22},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8905.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11269.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12568.22},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12568.22},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11809.07},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9169.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11354.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13931.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14277.3},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8817.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8817.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31877.97,"maximum":51619.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31877.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31877.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50367.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32196.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":45440.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":45440.08},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":32196.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":40743.59},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45440.08},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":45440.08},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42695.38},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41053.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50367.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51619.18},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31877.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31877.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16704.03,"maximum":27048.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16704.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16704.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26392.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16871.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23810.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23810.57},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16871.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21349.61},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23810.57},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23810.57},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22372.35},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17372.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21511.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26392.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27048.42},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16704.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16704.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11645.6,"maximum":18857.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11645.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11645.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18400.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11762.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16600.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16600.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11762.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14884.38},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16600.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16600.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15597.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12111.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14997.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18400.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18857.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11645.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11645.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23293.92,"maximum":37719.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23293.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23293.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23526.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":33204.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":33204.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":23526.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":29772.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33204.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":33204.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31198.44},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":24225.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29998.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37719.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":23293.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":23293.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11167.28,"maximum":18082.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11167.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11167.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17644.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11278.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15918.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15918.27},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11278.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14273.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15918.27},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15918.27},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14956.76},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11613.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14381.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17644.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18082.89},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11167.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11167.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8147.85,"maximum":13193.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8147.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8147.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12873.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8229.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11614.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11614.25},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8229.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10413.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11614.25},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11614.25},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10912.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10493.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12873.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13193.6},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8147.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8147.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11207.36,"maximum":18147.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17707.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11319.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":15975.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":15975.41},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11319.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14324.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15975.41},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":15975.41},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15010.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11655.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14433.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17707.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18147.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11207.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11207.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7587.99,"maximum":12287.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11989.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7663.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9698.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10816.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10162.88},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7891.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9772.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11989.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12287.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7587.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6514.47,"maximum":10548.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6514.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6514.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10292.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6579.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9285.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9285.98},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6579.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8326.22},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9285.98},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9285.98},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8725.08},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6775.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8389.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10292.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10548.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6514.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6514.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12244.87,"maximum":19827.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":17454.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":17454.31},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12367.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":15650.3},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17454.31},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":17454.31},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16400.02},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12734.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15769.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19346.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19827.8},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12244.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12244.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40382.52,"maximum":65390.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40382.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40382.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":63804.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40786.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":57562.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":57562.8},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":40786.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":51613.35},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":57562.8},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":57562.8},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54085.85},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41997.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52005.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63804.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65390.39},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":40382.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":40382.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27578.47,"maximum":44657.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27578.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27578.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43573.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27854.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":39311.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":39311.42},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":27854.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":35248.36},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39311.42},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":39311.42},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36936.9},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28681.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35516.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43573.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44657.12},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":27578.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27578.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16640.85,"maximum":26946.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26292.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16807.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":23720.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":23720.5},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":16807.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":21268.85},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23720.5},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":23720.5},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22287.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":17306.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21430.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26292.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26946.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":16640.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16640.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28329.93,"maximum":45873.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28329.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28329.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44761.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28613.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":40382.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":40382.58},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":28613.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":36208.81},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40382.58},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":40382.58},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37943.36},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":29463.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36484.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44761.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45873.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":28329.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28329.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10027.86,"maximum":16237.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15844.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10128.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14294.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14294.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10128.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12816.72},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14294.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14294.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13430.69},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10428.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12914.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15844.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16237.85},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10027.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10027.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1357.52,"maximum":2198.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":1357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":1357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":2144.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":1371.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":1935.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":1935.06},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":1371.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":1735.06},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":1935.06},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":1935.06},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1818.18},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":1411.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":1748.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2144.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2198.2},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":1357.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":1357.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7929.07,"maximum":12839.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12527.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11302.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11302.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10134.23},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11302.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11302.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10619.7},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8246.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10211.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12527.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12839.33},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7929.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6797.12,"maximum":11006.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10739.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6865.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9688.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9688.87},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6865.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8687.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9688.87},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9688.87},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9103.64},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7069.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8753.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10739.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11006.4},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6797.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6797.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6502.92,"maximum":10530.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10274.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6567.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9269.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9269.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6567.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8311.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9269.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9269.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8709.61},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6763.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8374.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10274.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10530.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6502.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6502.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30771.16,"maximum":49826.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48618.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31078.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":43862.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":43862.4},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31078.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39328.97},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":43862.4},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":43862.4},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41212.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32002.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39627.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48618.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49826.96},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":30771.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":30771.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19088.19,"maximum":30909.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19088.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19088.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19279.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":27209.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":27209.04},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":19279.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":24396.83},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27209.04},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":27209.04},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25565.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19851.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24582.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30909.02},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":19088.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":19088.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12969.83,"maximum":21001.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12969.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12969.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20492.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13099.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18487.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18487.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":13099.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16576.89},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18487.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18487.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17370.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16702.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20492.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21001.72},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12969.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12969.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27069.57,"maximum":43833.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27069.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27069.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42769.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27340.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":38586.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":38586.01},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":27340.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":34597.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38586.01},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":38586.01},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36255.31},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":28152.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34860.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42769.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43833.07},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":27069.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":27069.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12630.11,"maximum":20451.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19955.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12756.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":12756.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":16142.69},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":18003.45},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16915.99},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":13135.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16265.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19955.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20451.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12630.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9213.21,"maximum":14918.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9213.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9213.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14556.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9305.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13132.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13132.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9305.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11775.5},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13132.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13132.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12339.6},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9581.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11865.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14556.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14918.71},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9213.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9213.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7332.52,"maximum":11873.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7332.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7332.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11585.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7405.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10452.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10452.05},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7405.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9371.77},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10452.05},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10452.05},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9820.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7625.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9443.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11585.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11873.36},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7332.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7332.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5122.98,"maximum":8295.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5122.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5122.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5174.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":7302.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":7302.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5174.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6547.74},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7302.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":7302.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6861.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5327.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6597.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8295.51},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5122.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5122.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4580.79,"maximum":7417.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7237.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4626.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6529.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6529.63},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4626.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5854.75},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6529.63},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6529.63},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6135.22},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4764.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5899.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7237.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7417.55},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4580.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4580.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15001.36,"maximum":24291.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23702.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15151.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21383.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21383.51},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15151.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19173.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21383.51},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21383.51},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20091.89},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15601.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19319.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23702.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24291.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15001.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8601.03,"maximum":13927.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13589.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8687.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":12260.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":12260.24},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8687.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10993.08},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12260.24},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":12260.24},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11519.69},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8945.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11076.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13589.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13927.43},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8601.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8601.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7111.02,"maximum":11514.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11235.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7182.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":10136.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":10136.32},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7182.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":9088.67},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10136.32},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":10136.32},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9524.06},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7395.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9157.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11235.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11514.69},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7111.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7111.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9541.38,"maximum":15450.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9541.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9541.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15075.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9636.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13600.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13600.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9636.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12194.94},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13600.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13600.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12779.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9923.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12287.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15075.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15450.11},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9541.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9541.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6238.62,"maximum":10102.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6238.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6238.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9857.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6301.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8892.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8892.77},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6301.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7973.65},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8892.77},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8892.77},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8355.62},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6488.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8034.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9857.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10102.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6238.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6238.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10363.5,"maximum":16781.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10363.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10363.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10467.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14772.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14772.53},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10467.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13245.71},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14772.53},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14772.53},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13880.23},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10778.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13346.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16374.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16781.35},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10363.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10363.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":155.4,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14449.65,"maximum":23397.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14449.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14449.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22830.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14594.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20597.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20597.09},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14594.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18468.26},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20597.09},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20597.09},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19352.97},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15027.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18608.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22830.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23397.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14449.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14449.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6889.52,"maximum":11156.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6889.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6889.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10885.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6958.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":9820.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":9820.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":6958.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":8805.58},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9820.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":9820.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9227.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7165.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8872.5},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10885.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11156.03},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":6889.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6889.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4294.06,"maximum":6953.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4294.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4294.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6784.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4337.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6120.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6120.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4337.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":5488.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6120.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6120.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5751.2},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4465.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5530.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6784.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6953.26},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4294.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4294.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15502.1,"maximum":25102.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15502.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15502.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24493.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15657.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22097.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22097.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15657.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19813.41},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22097.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22097.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20762.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16122.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19964.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24493.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25102.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15502.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15502.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7876.07,"maximum":12753.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7876.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7876.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12444.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7954.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11226.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11226.85},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":7954.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10066.49},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11226.85},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11226.85},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10548.72},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8191.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10143.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12444.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12753.52},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":7876.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":7876.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5842.51,"maximum":9460.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9231.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5900.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":8328.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":8328.13},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":5900.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":7467.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8328.13},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":8328.13},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7825.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":6076.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7524.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9231.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9460.62},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":5842.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5842.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39847.8,"maximum":64524.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39847.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39847.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62959.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40246.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":56800.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":56800.59},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":40246.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":50929.92},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56800.59},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":56800.59},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53369.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":41441.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51317.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62959.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64524.53},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":39847.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":39847.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15209.95,"maximum":24629.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24031.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15362.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21680.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21680.84},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15362.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19440.0},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21680.84},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21680.84},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20371.26},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15818.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19587.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24031.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24629.08},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15209.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15209.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8180.46,"maximum":13246.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12925.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8262.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8262.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10455.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11660.74},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10956.4},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8507.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10535.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12925.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13246.41},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8180.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31150.97,"maximum":50441.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31150.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31150.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31462.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":44403.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":44403.79},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":31462.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":39814.4},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44403.79},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":44403.79},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41721.68},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32397.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40117.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50441.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31150.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31150.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15393.39,"maximum":24926.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15393.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15393.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24321.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15547.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":21942.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":21942.34},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15547.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":19674.47},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21942.34},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":21942.34},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20616.96},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16009.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19824.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24321.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24926.13},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15393.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15393.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9168.36,"maximum":14846.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9168.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9168.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14486.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9260.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13068.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13068.94},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9260.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":11718.19},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13068.94},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13068.94},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12279.54},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9535.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11807.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14486.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14846.1},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9168.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9168.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31782.85,"maximum":51465.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31782.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31782.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32100.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":45304.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":45304.49},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":32100.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":40622.02},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45304.49},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":45304.49},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42567.98},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33054.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40930.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50216.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51465.16},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":31782.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":31782.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15703.22,"maximum":25427.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15703.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15703.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24811.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15860.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":22383.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":22383.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":15860.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":20070.46},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22383.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":22383.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21031.92},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":16331.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20223.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24811.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25427.82},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":15703.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":15703.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11576.3,"maximum":18745.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11576.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11576.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18290.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11692.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":16501.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":16501.3},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":11692.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":14795.8},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16501.3},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":16501.3},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15504.58},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":12039.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14908.25},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18290.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18745.21},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":11576.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":11576.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21470.31,"maximum":34766.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21470.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21470.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33923.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21685.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":30604.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":30604.6},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":21685.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":27441.44},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30604.6},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":30604.6},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28756.0},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":22329.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27650.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33923.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34766.32},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":21470.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":21470.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10225.57,"maximum":16558.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10225.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10225.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16156.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10327.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":14575.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":14575.92},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":10327.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":13069.42},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14575.92},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":14575.92},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13695.5},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10634.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13168.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16156.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16558.01},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":10225.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10225.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8170.27,"maximum":13229.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8170.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8170.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12909.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8251.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11646.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11646.21},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8251.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10442.51},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11646.21},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11646.21},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10942.75},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8497.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10521.88},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12909.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13229.9},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8170.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8170.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4902.84,"maximum":7939.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4902.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4902.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7746.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4951.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":6988.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":6988.7},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":4951.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":6266.37},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6988.7},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":6988.7},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6566.56},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":5098.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6314.0},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7746.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7939.04},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":4902.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":4902.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3552.79,"maximum":5752.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3552.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3552.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5613.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3588.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":5064.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":5064.29},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":3588.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":4540.86},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":5064.29},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":5064.29},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4758.39},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3694.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4575.38},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5613.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5752.95},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":3552.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":3552.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37300.58,"maximum":60399.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37300.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37300.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37673.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":53169.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":53169.68},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":37673.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":47674.29},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":53169.68},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":53169.68},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49958.09},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":38792.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48036.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60399.88},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":37300.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":37300.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14171.76,"maximum":22947.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14171.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14171.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14313.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20200.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20200.97},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14313.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18113.09},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20200.97},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20200.97},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18980.78},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14738.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18250.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22947.97},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14171.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14171.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8285.77,"maximum":13416.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8285.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8285.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13091.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8368.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":11810.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":11810.86},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":8368.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":10590.14},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11810.86},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":11810.86},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11097.45},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8617.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10670.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13091.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13416.94},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":8285.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":8285.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32642.34,"maximum":52856.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32642.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32642.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51574.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32968.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":46529.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":46529.65},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":32968.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":41720.54},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":46529.65},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":46529.65},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43719.13},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":33948.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42037.62},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51574.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52856.91},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":32642.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":32642.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14182.63,"maximum":22965.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22408.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14324.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":20216.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":20216.47},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":14324.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":18126.98},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20216.47},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":20216.47},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18995.34},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14749.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18264.75},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22408.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22965.57},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":14182.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":14182.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9810.44,"maximum":15885.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9810.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9810.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15500.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9908.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"fee schedule","standard_charge_dollar":13984.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"fee schedule","standard_charge_dollar":13984.17},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"fee schedule","standard_charge_dollar":9908.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"fee schedule","standard_charge_dollar":12538.83},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13984.17},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"fee schedule","standard_charge_dollar":13984.17},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13139.49},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":10202.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12634.12},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15500.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15885.79},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"fee schedule","standard_charge_dollar":9810.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":9810.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":132.22,"10th_percentile":132.22,"90th_percentile":132.22,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"12","median_amount":88.93,"10th_percentile":11.95,"90th_percentile":118.58,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":179.37,"10th_percentile":179.37,"90th_percentile":183.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":215.8,"10th_percentile":215.8,"90th_percentile":215.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":148.43,"10th_percentile":148.43,"90th_percentile":148.43,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":79.92,"10th_percentile":79.92,"90th_percentile":141.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":37.12,"10th_percentile":36.35,"90th_percentile":136.0},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"15","median_amount":146.35,"10th_percentile":36.35,"90th_percentile":182.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23.09,"10th_percentile":23.09,"90th_percentile":145.59,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"87","median_amount":213.28,"10th_percentile":44.13,"90th_percentile":213.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"13","median_amount":115.77,"10th_percentile":35.0,"90th_percentile":163.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":175.17,"10th_percentile":59.0,"90th_percentile":188.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":169.42,"10th_percentile":169.42,"90th_percentile":169.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"53","median_amount":169.42,"10th_percentile":46.23,"90th_percentile":250.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"42","median_amount":135.98,"10th_percentile":46.23,"90th_percentile":182.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":135.54,"10th_percentile":135.54,"90th_percentile":135.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":51.0,"10th_percentile":51.0,"90th_percentile":51.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":142.55,"10th_percentile":41.61,"90th_percentile":329.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":55.08,"10th_percentile":55.08,"90th_percentile":100.44,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":145.6,"10th_percentile":145.6,"90th_percentile":145.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"14","median_amount":51.0,"10th_percentile":51.0,"90th_percentile":55.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"19","median_amount":430.0,"10th_percentile":48.1,"90th_percentile":580.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":147.09,"10th_percentile":147.09,"90th_percentile":149.09,"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":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":156.44,"10th_percentile":23.09,"90th_percentile":157.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"59","median_amount":144.25,"10th_percentile":60.31,"90th_percentile":935.2},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"178","median_amount":144.25,"10th_percentile":62.89,"90th_percentile":369.02,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"102","median_amount":64.78,"10th_percentile":64.78,"90th_percentile":360.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"887","median_amount":74.76,"10th_percentile":56.07,"90th_percentile":491.51,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":257.19,"10th_percentile":257.19,"90th_percentile":257.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"61","median_amount":115.77,"10th_percentile":53.9,"90th_percentile":255.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"15","median_amount":100.23,"10th_percentile":75.0,"90th_percentile":560.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"44","median_amount":75.0,"10th_percentile":60.0,"90th_percentile":281.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"377","median_amount":100.23,"10th_percentile":67.5,"90th_percentile":374.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"507","median_amount":75.0,"10th_percentile":60.0,"90th_percentile":356.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"15","median_amount":107.2,"10th_percentile":67.5,"90th_percentile":505.21,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"30","median_amount":53.9,"10th_percentile":53.9,"90th_percentile":162.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"86","median_amount":226.69,"10th_percentile":58.76,"90th_percentile":574.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"57","median_amount":88.26,"10th_percentile":58.21,"90th_percentile":215.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"14","median_amount":246.26,"10th_percentile":57.86,"90th_percentile":643.84,"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":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"112","median_amount":53.9,"10th_percentile":53.9,"90th_percentile":130.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"115","median_amount":72.91,"10th_percentile":58.33,"90th_percentile":723.2,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"21","median_amount":257.19,"10th_percentile":64.17,"90th_percentile":481.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"45","median_amount":67.91,"10th_percentile":62.89,"90th_percentile":352.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"71","median_amount":127.19,"10th_percentile":107.15,"90th_percentile":3804.35},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"181","median_amount":107.15,"10th_percentile":107.15,"90th_percentile":675.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"49","median_amount":110.37,"10th_percentile":110.37,"90th_percentile":701.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"326","median_amount":127.39,"10th_percentile":95.54,"90th_percentile":899.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"47","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":932.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"23","median_amount":148.93,"10th_percentile":119.14,"90th_percentile":1046.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"75","median_amount":148.93,"10th_percentile":119.14,"90th_percentile":569.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"299","median_amount":191.95,"10th_percentile":134.04,"90th_percentile":677.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"553","median_amount":148.93,"10th_percentile":119.14,"90th_percentile":627.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"26","median_amount":148.93,"10th_percentile":134.04,"90th_percentile":498.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"16","median_amount":71.5,"10th_percentile":65.52,"90th_percentile":246.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"71","median_amount":163.0,"10th_percentile":12.9,"90th_percentile":1409.27,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"27","median_amount":215.92,"10th_percentile":83.38,"90th_percentile":551.58,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"17","median_amount":114.02,"10th_percentile":107.68,"90th_percentile":800.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"61","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":300.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"104","median_amount":137.18,"10th_percentile":107.16,"90th_percentile":1062.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":395.52,"10th_percentile":109.34,"90th_percentile":642.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"18","median_amount":116.2,"10th_percentile":92.58,"90th_percentile":764.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"24","median_amount":1887.6,"10th_percentile":155.4,"90th_percentile":6553.6},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"77","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":1536.19,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"29","median_amount":598.63,"10th_percentile":160.06,"90th_percentile":1116.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"165","median_amount":1011.68,"10th_percentile":184.73,"90th_percentile":1510.38,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"19","median_amount":296.94,"10th_percentile":83.75,"90th_percentile":1985.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":863.07,"10th_percentile":863.07,"90th_percentile":1054.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"21","median_amount":482.01,"10th_percentile":215.86,"90th_percentile":1138.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"100","median_amount":802.35,"10th_percentile":194.27,"90th_percentile":1258.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"239","median_amount":552.68,"10th_percentile":194.27,"90th_percentile":1036.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"15","median_amount":851.64,"10th_percentile":194.27,"90th_percentile":1137.57,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"12","median_amount":212.08,"10th_percentile":83.75,"90th_percentile":561.58,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"14","median_amount":635.21,"10th_percentile":230.0,"90th_percentile":2266.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"21","median_amount":339.46,"10th_percentile":180.43,"90th_percentile":640.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":1412.0,"10th_percentile":566.02,"90th_percentile":2015.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"32","median_amount":197.82,"10th_percentile":83.75,"90th_percentile":509.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"28","median_amount":955.4,"10th_percentile":155.4,"90th_percentile":1224.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"24","median_amount":901.19,"10th_percentile":604.8,"90th_percentile":1225.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"17","median_amount":496.99,"10th_percentile":155.4,"90th_percentile":980.44,"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":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2023.08,"10th_percentile":2023.08,"90th_percentile":2023.08},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":188.58,"10th_percentile":188.58,"90th_percentile":1828.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1246.81,"10th_percentile":1246.81,"90th_percentile":1246.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":224.18,"10th_percentile":224.18,"90th_percentile":2246.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":623.94,"10th_percentile":252.84,"90th_percentile":1631.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":405.14,"10th_percentile":224.75,"90th_percentile":1525.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":192.43,"10th_percentile":192.43,"90th_percentile":192.43,"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":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":194.24,"10th_percentile":194.24,"90th_percentile":930.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":83.09,"10th_percentile":83.09,"90th_percentile":184.54,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":51.47,"10th_percentile":51.47,"90th_percentile":51.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"20","median_amount":152.63,"10th_percentile":62.8,"90th_percentile":267.61,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":567.5,"10th_percentile":95.2,"90th_percentile":615.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":91.83,"10th_percentile":91.83,"90th_percentile":91.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":149.12,"10th_percentile":149.12,"90th_percentile":149.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":183.66,"10th_percentile":44.57,"90th_percentile":317.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"18","median_amount":112.61,"10th_percentile":44.57,"90th_percentile":305.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":72.0,"10th_percentile":55.6,"90th_percentile":95.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":56.18,"10th_percentile":56.18,"90th_percentile":311.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":300.68,"10th_percentile":300.68,"90th_percentile":300.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":95.2,"10th_percentile":92.05,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":48.01,"10th_percentile":43.67,"90th_percentile":58.37,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":184.56,"10th_percentile":184.56,"90th_percentile":184.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1051.04,"10th_percentile":1051.04,"90th_percentile":1051.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":751.38,"10th_percentile":280.89,"90th_percentile":911.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":253.18,"10th_percentile":253.18,"90th_percentile":253.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":379.42,"10th_percentile":379.42,"90th_percentile":379.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":69.76,"10th_percentile":69.76,"90th_percentile":69.76,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":522.0,"10th_percentile":522.0,"90th_percentile":696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":210.54,"10th_percentile":210.54,"90th_percentile":210.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":2155.45,"10th_percentile":2155.45,"90th_percentile":2155.45,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":1458.96,"10th_percentile":1458.96,"90th_percentile":1458.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":370.12,"10th_percentile":370.12,"90th_percentile":370.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":1072.8,"10th_percentile":1072.8,"90th_percentile":1072.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":385.38,"10th_percentile":385.38,"90th_percentile":385.38,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":2537.72,"10th_percentile":2537.72,"90th_percentile":2537.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2923.52,"10th_percentile":2923.52,"90th_percentile":2923.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":118.09,"10th_percentile":118.09,"90th_percentile":140.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":783.44,"10th_percentile":783.44,"90th_percentile":783.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":1305.63,"10th_percentile":1305.63,"90th_percentile":1305.63,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":405.31,"10th_percentile":405.31,"90th_percentile":405.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":655.31,"10th_percentile":114.7,"90th_percentile":1802.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":55.45,"10th_percentile":55.45,"90th_percentile":55.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":273.0,"10th_percentile":64.11,"90th_percentile":1261.99},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"24","median_amount":80.47,"10th_percentile":31.14,"90th_percentile":254.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":56.45,"10th_percentile":31.95,"90th_percentile":81.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"43","median_amount":118.58,"10th_percentile":88.93,"90th_percentile":138.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":49.64,"10th_percentile":49.64,"90th_percentile":63.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":76.62,"10th_percentile":61.3,"90th_percentile":164.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":61.3,"10th_percentile":61.3,"90th_percentile":71.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"27","median_amount":76.62,"10th_percentile":61.3,"90th_percentile":229.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"62","median_amount":76.62,"10th_percentile":36.62,"90th_percentile":163.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":76.62,"10th_percentile":71.92,"90th_percentile":164.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":46.0,"10th_percentile":46.0,"90th_percentile":46.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":173.95,"10th_percentile":155.1,"90th_percentile":182.47,"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":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":37.8,"10th_percentile":23.62,"90th_percentile":110.37,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":224.64,"10th_percentile":224.64,"90th_percentile":252.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":20.26,"10th_percentile":20.26,"90th_percentile":44.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"14","median_amount":108.88,"10th_percentile":50.66,"90th_percentile":154.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":68.6,"10th_percentile":12.25,"90th_percentile":86.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"14","median_amount":211.83,"10th_percentile":96.79,"90th_percentile":838.47},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"29","median_amount":77.44,"10th_percentile":47.79,"90th_percentile":97.79,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":97.76,"10th_percentile":48.76,"90th_percentile":97.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"78","median_amount":143.22,"10th_percentile":85.93,"90th_percentile":143.22,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":63.56,"10th_percentile":63.56,"90th_percentile":90.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"12","median_amount":86.08,"10th_percentile":86.08,"90th_percentile":161.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"20","median_amount":86.08,"10th_percentile":78.83,"90th_percentile":184.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"42","median_amount":107.6,"10th_percentile":80.7,"90th_percentile":215.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"108","median_amount":101.45,"10th_percentile":67.6,"90th_percentile":215.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":172.16,"10th_percentile":107.6,"90th_percentile":584.07,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":40.0,"10th_percentile":40.0,"90th_percentile":40.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"21","median_amount":200.39,"10th_percentile":96.98,"90th_percentile":221.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":60.48,"10th_percentile":60.48,"90th_percentile":70.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":419.04,"10th_percentile":280.8,"90th_percentile":1450.64,"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":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":415.0,"10th_percentile":415.0,"90th_percentile":415.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"16","median_amount":174.35,"10th_percentile":96.8,"90th_percentile":348.7,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":103.99,"10th_percentile":82.85,"90th_percentile":272.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2499.7,"10th_percentile":800.8,"90th_percentile":3893.12},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"12","median_amount":220.03,"10th_percentile":176.03,"90th_percentile":220.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":223.14,"10th_percentile":222.23,"90th_percentile":223.38,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"24","median_amount":325.55,"10th_percentile":227.88,"90th_percentile":325.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":206.66,"10th_percentile":167.8,"90th_percentile":357.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"18","median_amount":178.98,"10th_percentile":178.98,"90th_percentile":359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"11","median_amount":223.73,"10th_percentile":219.03,"90th_percentile":447.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"49","median_amount":201.36,"10th_percentile":76.93,"90th_percentile":289.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":223.73,"10th_percentile":219.03,"90th_percentile":357.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":406.0,"10th_percentile":406.0,"90th_percentile":406.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":425.82,"10th_percentile":425.82,"90th_percentile":425.82,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":873.72,"10th_percentile":873.72,"90th_percentile":873.72,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":962.16,"10th_percentile":421.92,"90th_percentile":1738.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":294.57,"10th_percentile":257.75,"90th_percentile":368.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":191.34,"10th_percentile":191.34,"90th_percentile":191.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":162.7,"10th_percentile":162.7,"90th_percentile":162.7,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":125.64,"10th_percentile":125.64,"90th_percentile":125.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":179.82,"10th_percentile":164.76,"90th_percentile":194.92,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":626.93,"10th_percentile":626.93,"90th_percentile":626.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":203.38,"10th_percentile":203.38,"90th_percentile":203.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"11","median_amount":195.54,"10th_percentile":126.31,"90th_percentile":244.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":254.04,"10th_percentile":220.55,"90th_percentile":359.34,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":1280.0,"10th_percentile":1280.0,"90th_percentile":1280.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":167.7,"10th_percentile":167.7,"90th_percentile":727.12,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":2114.56,"10th_percentile":2114.56,"90th_percentile":2114.56},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":31.09,"10th_percentile":31.09,"90th_percentile":31.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":328.34,"10th_percentile":53.94,"90th_percentile":610.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"30","median_amount":854.05,"10th_percentile":480.99,"90th_percentile":1202.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":294.74,"10th_percentile":37.0,"90th_percentile":1397.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":260.07,"10th_percentile":99.9,"90th_percentile":444.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":416.6,"10th_percentile":135.27,"90th_percentile":921.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"13","median_amount":362.99,"10th_percentile":135.07,"90th_percentile":445.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":352.7,"10th_percentile":352.7,"90th_percentile":417.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":666.13,"10th_percentile":666.13,"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":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":960.0,"10th_percentile":880.0,"90th_percentile":1920.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":245.18,"10th_percentile":245.18,"90th_percentile":245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":832.59,"10th_percentile":832.59,"90th_percentile":832.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1872.31,"10th_percentile":990.65,"90th_percentile":2203.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":2335.13,"10th_percentile":2335.13,"90th_percentile":2335.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":3263.55,"10th_percentile":3263.55,"90th_percentile":3263.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":2359.38,"10th_percentile":2359.38,"90th_percentile":2359.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":913.0,"10th_percentile":739.2,"90th_percentile":1188.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":945.7,"10th_percentile":945.7,"90th_percentile":945.7},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":372.93,"10th_percentile":372.93,"90th_percentile":372.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":1872.31,"10th_percentile":1872.31,"90th_percentile":1872.31,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":277.56,"10th_percentile":277.56,"90th_percentile":287.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":6204.81,"10th_percentile":6204.81,"90th_percentile":6204.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":824.6,"10th_percentile":824.6,"90th_percentile":824.6},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1271.96,"10th_percentile":1271.96,"90th_percentile":1271.96,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":559.2,"10th_percentile":559.2,"90th_percentile":559.2,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":116.18,"10th_percentile":116.18,"90th_percentile":116.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":304.12,"10th_percentile":304.12,"90th_percentile":304.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":2733.64,"10th_percentile":2733.64,"90th_percentile":2733.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":823.0,"10th_percentile":592.54,"90th_percentile":4628.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":158.79,"10th_percentile":158.79,"90th_percentile":158.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2865.05,"10th_percentile":2865.05,"90th_percentile":2865.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":259.64,"10th_percentile":259.64,"90th_percentile":259.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":49.86,"10th_percentile":40.92,"90th_percentile":54.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":132.22,"10th_percentile":132.22,"90th_percentile":132.22,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":53.5,"10th_percentile":53.5,"90th_percentile":53.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":27.01,"10th_percentile":27.01,"90th_percentile":27.01,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":51.46,"10th_percentile":51.46,"90th_percentile":51.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":53.5,"10th_percentile":53.5,"90th_percentile":53.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":1196.32,"10th_percentile":1196.32,"90th_percentile":1196.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":404.75,"10th_percentile":404.75,"90th_percentile":469.95,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tenecteplase injection","code_information":[{"code":"9002","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":5640.31,"10th_percentile":5640.31,"90th_percentile":5640.31,"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":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"1 through 10","median_amount":833.55,"10th_percentile":833.55,"90th_percentile":833.55,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":596.09,"10th_percentile":596.09,"90th_percentile":596.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":409.73,"10th_percentile":409.73,"90th_percentile":409.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies ig ht&sol human im/sc","code_information":[{"code":"9201","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"1 through 10","median_amount":751.34,"10th_percentile":751.34,"90th_percentile":751.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":4236.64,"10th_percentile":4236.64,"90th_percentile":4236.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":3048.18,"10th_percentile":3048.18,"90th_percentile":3048.18,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":369.6,"10th_percentile":369.6,"90th_percentile":846.78},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"15","median_amount":32.19,"10th_percentile":16.68,"90th_percentile":178.51,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":80.66,"10th_percentile":35.06,"90th_percentile":179.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"20","median_amount":90.46,"10th_percentile":25.45,"90th_percentile":372.93,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":433.4,"10th_percentile":433.4,"90th_percentile":433.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":402.56,"10th_percentile":402.56,"90th_percentile":402.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":1035.45,"10th_percentile":950.94,"90th_percentile":1956.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":224.56,"10th_percentile":224.56,"90th_percentile":224.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"14","median_amount":44.72,"10th_percentile":10.74,"90th_percentile":135.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"35","median_amount":36.34,"10th_percentile":15.44,"90th_percentile":104.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":9.64,"10th_percentile":5.88,"90th_percentile":135.27,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":24.53,"10th_percentile":24.53,"90th_percentile":24.53,"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":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":548.44,"10th_percentile":76.08,"90th_percentile":3094.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":45.22,"10th_percentile":45.22,"90th_percentile":182.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"13","median_amount":11.1,"10th_percentile":11.1,"90th_percentile":197.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":83.94,"10th_percentile":7.29,"90th_percentile":904.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"1 through 10","median_amount":72.04,"10th_percentile":72.04,"90th_percentile":72.04,"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":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":254.1,"10th_percentile":254.1,"90th_percentile":270.56},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"24","median_amount":95.04,"10th_percentile":95.04,"90th_percentile":95.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"16","median_amount":96.0,"10th_percentile":96.0,"90th_percentile":96.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"30","median_amount":140.62,"10th_percentile":140.62,"90th_percentile":140.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"35","median_amount":135.27,"10th_percentile":135.27,"90th_percentile":135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"18","median_amount":135.27,"10th_percentile":135.27,"90th_percentile":135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"78","median_amount":135.27,"10th_percentile":135.27,"90th_percentile":135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":135.27,"10th_percentile":135.27,"90th_percentile":135.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"13","median_amount":96.98,"10th_percentile":96.98,"90th_percentile":96.98,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":131.41,"10th_percentile":131.41,"90th_percentile":131.41,"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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":217.8,"10th_percentile":217.8,"90th_percentile":231.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"22","median_amount":195.39,"10th_percentile":195.39,"90th_percentile":195.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"1 through 10","median_amount":62.88,"10th_percentile":62.88,"90th_percentile":62.88,"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":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"1 through 10","median_amount":504.96,"10th_percentile":86.4,"90th_percentile":852.05,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 210.7706] [ED Level 2--99282 ($): 240.5764] [ED Level 3--99283 ($): 289.1972] [ED Level 4--99284 ($): 352.231] [ED Level 5--99285 ($): 454.7408] [Critical Care ($): 530.4126]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 445.29] [ED Level 2--99282 ($): 508.26] [ED Level 3--99283 ($): 610.98] [ED Level 4--99284 ($): 744.15] [ED Level 5--99285 ($): 960.72] [Critical Care ($): 1120.59]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Hemodialysis ($): 350] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 60] [Physical Therapy ($): 60] [Speech Therapy ($): 60] [APC ($): 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5000] [Cardiac Cath ($): 10000] [Observation (%BC): 40] [ED Level 1--99281 ($): 450] [ED Level 2--99282 ($): 1250] [ED Level 3--99283 ($): 1250] [ED Level 4--99284 ($): 1250] [ED Level 5--99285 ($): 2015] [Critical Care ($): 2015] [Cardiac Rehabilitation Therapy (%BC): 40] [Cardiac Stress Test (%BC): 40] [Cardiology (%BC): 40] [Echocardiology (%BC): 40] [EKG/ECG  (%BC): 40] [Electrophysiology (%BC): 40] [Electrophysiologic Ablation (%BC): 40] [Electrophysiology and Mapping Studies (%BC): 40] [Holter Monitor/Telemetry (%BC): 40] [Other Cardiac Testing (%BC): 40] [Peripheral Vascular Lab (%BC): 40] [EEG (%BC): 40] [EMG (%BC): 40] [MEG (%BC): 40] [Neuropsychological Testing and Biofeedback (%BC): 40] [Sleep Studies (%BC): 40] [Chemotherapy (%BC): 40] [Gamma Knife (%BC): 40] [Nuclear Medicine (%BC): 40] [Oncology (%BC): 40] [Radiation Therapy  (%BC): 40] [CT Scan OP ($): 1600] [MRI OP ($): 2400] [Imaging Services (%BC): 40] [Mammography-Diagnostic (%BC): 40] [Mammography-Screening (%BC): 40] [Positron Emission Tomography (%BC): 40] [Radiology (%BC): 40] [Ultrasound Imaging (%BC): 40] [Laboratory (%BC): 40] [Reference Lab (%BC): 40] [Hemodialysis ($): 825] [Peritoneal Dialysis, CAPD, and CCPD ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[APC ($): 145% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 347] [Observation ($): 3383] [ED Level 1--99281 ($): 415] [ED Level 2--99282 ($): 748] [ED Level 3--99283 ($): 994] [ED Level 4--99284 ($): 1294] [ED Level 5--99285 ($): 1346] [Critical Care ($): 1447] [Urgent Care ($): 209] [Cardiac Rehabilitation Therapy ($): 198] [Cardiac Stress Test ($): 835] [Cardiology ($): 955] [Echocardiology ($): 559] [EKG/ECG ($): 135] [Holter Monitor/Telemetry ($): 319] [Peripheral Vascular Lab ($): 398] [EEG ($): 557] [EMG ($): 418] [Neuropsychological Testing and Biofeedback ($): 173] [Sleep Studies-Attended ($): 1598] [Sleep Studies-Unattended ($): 1598] [Chemotherapy ($): 319] [Nuclear Medicine Fee Schedule: Fee Schedule] [Oncology ($): 383] [Radiation Therapy ($): 347] [CT Scan OP ($): Fee Schedule] [MRI OP ($): Fee Schedule] [Imaging Services ($): Fee Schedule] [Mammography-Diagnostic Fee Schedule: Fee Schedule] [Mammography-Screening Fee Schedule: Fee Schedule] [Positron Emission Tomography ($): Fee Schedule] [Radiology Fee Schedule: Fee Schedule] [Ultrasound Imaging ($): Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 418] [Peritoneal Dialysis, CAPD, and CCPD ($): 418] [Occupational Therapy ($): 184] [Physical Therapy ($): 184] [Resp. Services/Therapy ($): 184] [Speech Therapy ($): 184] [OP High Cost Drugs (%BC): 47.56] [Other Outpatient Implant (%BC): 47.56] [Hyperbarics ($): 556] [IV Therapy ($): 145] [Pulmonary Function ($): 184] [Pulmonary Rehabilitation ($): 173]","count":"1 through 10","median_amount":10.54,"10th_percentile":10.54,"90th_percentile":10.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement With Mcc","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement Without Mcc","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures With Mcc","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures Without Mcc","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection With Mcc Or Insert","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection Without Mcc","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Prosthesis","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Mcc","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Cc","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical Without Cc/Mcc","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Mcc","code_information":[{"code":"731","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Cc","code_information":[{"code":"732","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"733","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent 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":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62] [SNF-Per Diem: 794.14] [ECT (%BC): 693.84]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 875] [Surgical-Per Diem: 875] [ICU-Per Diem: 875] [CCU-Per Diem: 875] [Alcohol/ Chemical Dependency-Per Diem: 875] [Psych-Per Diem: 875]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 101% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1300] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1060] [Lower Level Neonate-Per Diem: 1060] [Higher Level Neonate-Per Diem: 1060]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS + 3 days | Threshold Excess Per Diem: 1768] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: CMS AMLOS +3 days | Threshold Excess Per Diem: 1326] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1326] [Lower Level Neonate-Per Diem: 1326] [Higher Level Neonate-Per Diem: 1326]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 850] [Surgical-Per Diem: 850] [ICU-Per Diem: 850] [CCU-Per Diem: 850] [Step Down-Per Diem: 850] [C-Section-Per Diem: 850] [Normal Vaginal Delivery-Per Diem: 850] [Normal Newborn-Per Diem: 850] [Nursery  Level 1- Boarder-Per Diem: 850] [Nursery  Level 2-Per Diem: 850] [Nursery  Level 3-Per Diem: 850] [Nursery  Level 4-NICU-Per Diem: 850] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 104% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/] [Per Discharge Additional ($): 3063]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 158% of Medicare] [C-Section-Case Rate: 5623.88 Days: 4 Additional Days: 1734.6] [Normal Vaginal Delivery-Case Rate: 3304 Days: 2 Additional Days: 1734.6] [Normal Newborn-Per Diem: 826] [Lower Level Neonate-Per Diem: 902.7] [Higher Level Neonate-Per Diem: 1231.92] [Severe Level Neonate-per diem: 1318.06] [Nursery  Level 4-NICU-Per Diem: 1386.5] [Alcohol/ Chemical Dependency-Per Diem: 1077.34] [Psych-Per Diem: 1077.34] [Rehab-Per Diem: 954.62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318 | Threshold Total (% BC): 42.98] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Augmnt alg alys enceph wvfrm","code_information":[{"code":"1041T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":125.01,"maximum":181.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":125.01,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":181.26,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":126.26,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":130.01,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/ash","code_information":[{"code":"0002M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":729.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":729.93,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":508.43,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/nash","code_information":[{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.4,"maximum":729.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":729.93,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":508.43,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"}]}]},{"description":"Scoliosis dna alys","code_information":[{"code":"0004M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.0,"maximum":114.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":114.55,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":79.79,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":82.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc hep gene risk classifier","code_information":[{"code":"0006M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.0,"maximum":217.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":217.5,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":151.5,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":156.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc gastro 51 gene nomogram","code_information":[{"code":"0007M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":375.0,"maximum":543.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":375.0,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":543.75,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":378.75,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":390.0,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.12,"maximum":261.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":180.12,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":261.17,"additional_payer_notes":"APC"},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":181.92,"additional_payer_notes":"APC"},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"fee schedule","standard_charge_dollar":187.32,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing","code":"PI","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy","code":"PS","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","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":"Blue Cross","plan_name":"True Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"United Healthcare","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Health Advantage Medicare","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."},{"payer_name":"Empower","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Qualchoice","plan_name":"Commercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","description":"The modified price is presented in the standard charge value."}]}]}